Make your own free website on Tripod.com
Mighty Mutts Pre-Screening Adoption Application
for Dogs

If you are interested in adopting one of our dogs, please fill out and submit the following application.  The following procedure then follows.

Please Note:
Mighty Mutts can not accept applications from outside the New York City/Tri-state area since we performs in-home interviews on all promising applicants.
Completion of this application, interview, and home visit do not guarantee adoption.


xxxxx

Date 
Name of dog you are interested in adopting: 
Have you previously met this dog at Union Square?YesNo 
PERSONAL CONTACT INFORMATION
NAME: 
First:  Last: 
Gender: Male    Female 
Age: 
E-Mail:
Primary Telephone Number*: Area Code:   Number:
Alternate Telephone Number*: Area Code:   Number:
* Telephone number is required so that one of our screeners can contact you personally
Is your home phone telephone listed in your own name? Yes No

Your  current address
Street:   Apt. Num: 
City:   State:     Zip Code:
How long have you lived at your current address? 
Have you confirmed that pets are allowed? Yes No I don't know
Do you: own rent sublet


 


How Do You Plan to Care for the Dog?

Why do you want to adopt this particular dog?

Where will your adopted dog be during the daytime?

How much time will your adopted dog spend outside?

Where will your adopted dog be during the evenings and at night time?

Where will your adopted dog sleep?

Does your budget allow for the cost of maintaining a pet, and can you cope with vet expenses? Yes No
What would you estimate the cost of maintaining a pet to be per month? $
Do you belive that you would need the services of a dogwalker? Yes No


Sometimes, due to unforseen circumstances, people become unable to care for their pets.Please give three circumstances where you would no long be able to care for your dog:
1)
2)
3)
If you can no longer care for your dog, what provisions will be made for the dog's future?

Are you willing to allow a follow-up visit by an Mighty Mutts representative? Yes No


BRIEFLY DESCRIBE YOUR RESIDENCE

I share my home with: 

husband  wife partner roommate no other person
Do you have children? No Yes

Do all members of your household wish to adopt a dog? Yes No
Does anyone in your home have allergies to animals? Yes No

How many windows have window guards? 
How many windows do not window guards? 
How many windows have screens? 
How many windows do not have screens? 

Does the residence in which your pet will be living have: (please check all appropriate boxes)

Terrace:  Balcony Deck Yard

What was your previous address?
Street:  Apt. Num: 
City:  State:  Zip Code:
How long did you live at your previous address? 



BRIEFLY DESCRIBE YOUR LIFESTYLE

Who is your current employer? 
Occupation:
How long have you worked at this company? 
How many hours per day do you work? 
Does your job require travel? Yes No

Who was your previous employer? 
How long did you work at this company? 


WHAT IS YOUR PREVIOUS PET EXPERIENCE?

Do you presently share your home with any animals?
 

dog cat other no pets

If other, what type? 
 
If you have dogs:
  • How many?
  • What breed(s)? 
  • What gender(s)? 
  • How old are they?Yrs/Mos
  • How long have you had them?   Yrs /Mos 
  • Are they spayed/neutered? Yes No
  • Are they vaccinated? Yes No

  •  
If you have cats:
  • How many?
  • What breed(s)?
  • What gender(s)? 
  • How old are they?Yrs/Mos 
  • How long have you had them?   Yrs /Mos 
  • Are they spayed/neutered? Yes  No
  • Are they vaccinated? Yes No
  • Are they declawed? Yes   No
  • Has this/Have these/ cat(s) been screened for FiV/FelV?  Yes No

  •  

If not currently, have you ever shared your home with a pet?YesNo
If yes, when? 
Where is this pet now? 

Were you ever in a situation where you were not able to keep a pet? Yes No

If yes, give details:

Which veterinarian will you use?
Name of Veterinarian 
Street: 
City:  State:  Zip Code:
Telephone Number:   Area Code:   Number: 

Have you ever used this veterinarian before? Yes  No

I certify that the above information is true.  I understand that completion of this application is not a guarantee of adoption through Mighty Mutts, Inc.YesNo