Adoption Application

First Name *

Last Name *

Email *

Phone *

Address *

City *

Postal code *

State *

Date of birth *

Place of Employment *

Name of animal you are interested in: *

Do you currently live in a: *

House

Condo

Apartment

Other

How long have you lived at your current residence?

If you are not the property owner, we will need to verify your landlord’s current pet policy. *

Landlords Name
Landlords Phone #

How many adults & children live in your home? *

Name & Age
Name & Age
Name & Age
Name & Age

Does anyone in your household have dog or cat allergies? *

Yes

No

Who will be primarily responsible for the care of this animal? *

How many hours will the animal be alone each day? *

Where will the animal be kept at night? *

Where will the animal be kept when no one is home? *

Do you have a fence? *

If Yes, how high is it and what type of fence is it?

If you have pets, are their vaccinations current? *

Yes

No

Are they currently licensed? *

Yes

No

Please list any veterinarian you may have worked with in the past, for current or previous pets *

Name & Phone Number
Name & Phone Number

Personal References- We require 3 but please only one family member *

Name & Phone Number
Name & Phone Number
Name & Phone Number
Name & Phone Number

Under what circumstances would you NOT keep this dog? *

Please list all of the pets you have had in the last 7 years including current pets and those you no longer own: *

Species
Breed
Age
Sex
Altered?
Owned how long?
What happened to him or her?

When it comes to relating to dogs, I tend to be more *

Strict, demanding (dog must learn and follow all commands)

Moderate (encouraging of good behavior)

Lenient, wishy-washy, easily coerced by the dog

The noise/activity in my home is usually: *

High

Medium

Low

I would prefer a pet that: *

Would enjoy walking with me on leash

Will exercise him/herself in our yard

Would enjoy going to the dog park

Would run, jog or hike with me

Requires only enough exercise to do his/her business

My ideal pet would: *

Bad pet habits that I cannot tolerate are: *

Anything else you'd like to mention:

I understand and agree that Kane’s Mission – Dog Rescue makes no express or implied warranty, representation or promise to the age, health, breed, habits, disposition or safety of the animal. I hereby accept the animal as is, assume all risks and responsibilities associated with the ownership of the Animal, including bites, and I hereby fully and completely release, indemnify and hold harmless Kane’s Mission – Dog Rescue, its directors, officers, volunteers, and employees from any claim, cause of action or liability of any sort or nature, whether known or unknown, directly or indirectly arising out of or in connection with the adoption, care or ownership, maintenance, temperament or condition of the Animal. *

Clear

I agree in the case I cannot keep the animal, he/she will be returned to Kane’s Mission – Dog Rescue. All monies deposited with KMDR with be considered a donation to the rescue and are non-refundable. *

Clear

I agree to allow KMDR to perform a criminal history background check. *

Clear

I acknowledge falsification of the above can result in my being denied adoption of an animal or if animal has been adopted to me, the return of that animal to Kane’s Mission – Dog Rescue. *

Clear

I certify that the above information is true and correct to the best of my knowledge *

Clear

Signature & Date *

Clear

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Let's Stay Connected!

[email protected]

+216 5533385

PO Box 24069 Lyndhurst, OH 44124-0069