Mary Ann Morris Animal Shelter and Safe Haven Puppy Rescue P.O. Box 1151 254 Slow Pitch Road Bamberg, SC 29003 ADOPTION APPLICATION The purpose of the application process is to find the best possible match for both the dog and the adoptive person/family. Considerations are not on a first-come, first-serve basis. You may submit one application for multiple dogs. You must be over the age of 21 years for your application to be considered. Dog(s) you re interested in: (if more than one, please list top five in order of preference): 1*), 2), 3), 4), 5) Date*: PH: (803) 245-7387(PETS) Email: mamas.animal.society@gmail.com Web: www.mamasanimalshelter.com ABOUT YOU Thank you! Name*: Email*: Current Street Address*: City*: State*: Zip*: Cell Phone*: Other Phone: Previous Street Address (If less than 2 years): City: State: Zip: Employer*: How Long*? If less than two (2) years, please list previous employer. Names of other living in the home (if children, please include ages): 1. Does anyone in your household have any allergies to pets? Yes No If yes, please explain: 2. How d you hear about us?: Website Facebook Pinterest Event Referral
If referral, please let us know who referred you. 3. Home: Own Rent 4. Type of Dwelling: Single Family Townhouse Condo/Apt 5. Home Location: Urban Suburban Rural 6. If rental, does your lease allow pets?* Yes No 7. Are there size/breed restrictions?* Yes No 8. If owner, does your HOA have pet restrictions?* Yes No *Please provide a copy of your lease or HOA rules at your interview. 9. Fenced yard? Yes No Partially (Explain): If yes, fence type: Wood Chain Link Other (Specify): If you have a fence, do you have locks on the gates? Yes No If no, are you willing to fence? Yes No If yes, when? Type of fence contemplated? Wood Chain Link Other (Specify): 10. Fence height? 11. Is the fence attached to your home? Yes No 12. Do you have a dog door? Yes No 13. Do you use a lawn service to maintain your yard? Yes No 14. Do you have a pool? Yes No PET HISTORY Have you owned a pet of any kind in the last 15 years? Yes No (If yes, please provide us with the information for your last three pets) If you no longer have the pet, please provide reasons/circumstances/location information. If your pet died, please provide cause of death: 2
If you no longer have the pet, please provide reasons/circumstances/location information. If your pet died, please provide cause of death: If you no longer have the pet, please provide reasons/circumstances/location information. If your pet died, please provide cause of death: CURRENT PET INFORMATION Do you currently own a Pet? Yes No If yes, Please provide the following information: What year did you get your pet? How old was it? How/where did you get the pet? What year did you get your pet? How old was it? How/where did you get the pet? 3
What year did you get your pet? How old was it? How/where did you get the pet? 1. What causes heartworm in dogs? 2. Are your current pets on heartworm preventative? Yes No 3. Have you/do you take any steps to prevent flea/tick-borne diseases? Yes No YOU AND YOUR NEW FAMILY MEMBER 1. Who will be the primary caretaker of the dog? 1a. Who will walk the dog? 1b. Who will feed the dog? 2. Canine companion I/we have in mind: Puppy Young Adult Adult Senior Special Needs 3. Size: Under 25 lbs 26 50 lbs 51 80 lbs Over 81 lbs 4. Dog Energy level: Very active Moderately active Couch potato/tv pal 5. Why did you decide to get a dog at this time? 6. Have you previously applied to adopt a dog from a rescue group or shelter? Yes No If yes, when? What is the name of the organization? 7. How many weeks are you generally away on vacation or business travel each year? 8. Who will care for the dog in your absence? 9. Will your dog ever travel with you? Yes No 4
10. Where will your dog sleep (please be specific): 11. Where will your dog be exercised? 12. Do you use or have you ever used retractable leashes? Yes No 13. Where and how will your dog be exercised off leash 14. Number of hours your dog will be left alone: Work days: Weekends: 15. Where will your dog be left when you are not home? Crated Free roam of house Confined to portion of house (please specify): Outdoors Other (please explain): 16. How much time will you and your family have to play with the dog? Weekdays: Weekends: 17. What kind of toys or treats have you used in the past or plan to use with your new dog? 18. What type/brand of food do you anticipate feeding your new dog? 19. How much do you think it costs annually to own a dog? Medical: Food and supplies: 20. Have you ever incurred extraordinary medical expenses for any pet, current or past? Yes No If yes, please elaborate: 21. Have you dealt with behavior issues previously with a dog? Yes No If yes, please describe: 22. Are you willing to get professional training for your dog if she/he would benefit from it? Yes No 23. Describe any and all circumstances which may cause you to return your adopted dog. (Please include possible situations relating to both you and your dog): 24. If you had to give up your dog, would you: Find him/her a new home Take to an animal shelter Give to family member Return to M.A.M.A.S. Other (please explain): 5
VETERINARIAN CONTACT INFORMATION Please list below the information for your current veterinarian. Please also provide the information for the last three veterinarians (if different) and the dates (from-to) and the pet names. Veterinarian (Current): Veterinarian Previous: Dates Veterinarian Previous: Dates Veterinarian Previous: Dates By signing or submitting this application, I attest that I have answered all questions fully and accurately. Print Full Name*: Signature**: *Required fields must be completed in order to submit form. **If the submit button doesn t work on your device, please click the print button, sign and email directly to: mamas.animal.society@gmail.com In order to submit online, please download to your computer and open in Adobe Acrobat Reader. 6