Dog Adoption Application Michigan Anti-Cruelty Society Pre-Adoption Dog Application This questionnaire must be completed by anyone who wishes to adopt an animal from the Michigan Anti-Cruelty Society (MACS). MACS tries to place all animals in permanent, responsible homes while trying at the same time to find a suitable pet for you. Please do not consider this an invasion of privacy. It is the policy of MACS, within reasonable limits, to ensure each animal finds the most compatible home as possible. Date* Dog name (if named) along with control# or tag#Where did you see pet?*At ShelterPet Smart-UticaMACS websitePetfinderAdopt-A-PetFaceBookTV/Radio/NewspaperHave all family members met the pet?YesNoWhat are the age range(s) you are looking for? Under 1yr 1-3yrs 3-5yrs 5-8yrs 8+yrs Applicant Name* First Last Are you employed?*YesNoCo-Applicant Name First Last Is Co-Applicant employed?YesNoAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Cell Phone*Home PhoneEmail* Enter Email Confirm Email Applicant's Drivers License / State ID #*How long have you lived at this address?*What type of home do you live in?*ApartmentCondoHouseMobile HomeTown HomeDo you:*OwnRentLive with parentsIf renting, Landlord name:PhoneHow many adults live in the home?How many children?If there are children that reside in the home, what are their ages?What is the activity level of your home?HighModerateLowDoes anyone in the house have allergies to pets?*YesNoIf yes, what kind?Does everyone in the household know that you are adopting a pet?*YesNoWho will be the primary caregiver of the new pet?*Who will be the caregiver for the pet when you go on vacation?*How many hours a day will the pet be alone?*4 hours or less4-6 hours6-9 hours10+ hoursWhere will the pet be kept while alone?*Where will the pet be kept while you are sleeping?*Have you ever owned a pet?*YesNoGrew up with oneWhen was the last time you had a pet?1 yr or less2-5 yrsover 5 yrsHave you ever adopted a pet from this or any other shelter or rescue?YesNoIf yes, when and where?Have you ever surrendered an animal to this or any other organization?YesNoIf yes, where/when? Please explain.List pets that you have owned in the last 5 years, alive or deceased.NameSpecies/BreedAgeSex M/FSterilized Y/NAlive Y/N MaleFemaleYesNoYesNo If deceased, what happened?Veterinarian's NameVeterinarian's PhoneWhere does your pet(s) live?Primarily OutsidePrimarily InsideInside & OutsideWhy do you want to adopt a dog? Guard/Watch dog Hunting dog Breeder Companion Gift I am adopting this dog for: Myself My family My children A relative Companion for another pet Is there anyone in the home that is nervous or unsure of dogs?Very (e.g. been bit)Somewhat (no exp.)NoDo you have a yard that is fenced?No yardPartially fencedCompletely fencedUnfenced yardDog runTie outUnderground/Invisible fenceWhere will this dog live?Primarily OutsidePrimarily InsideInside & OutsideConsidering the activity level of your family, what energy level is a good fit for your home?Highly Active (jogging, hiking, etc...)Somewhat Active (walks, plays outside, etc....)Couch potato (walks, low energy)This dog may or may not be housebroken, so there may be accidents in your home. How would you house break/potty train this pet? Please explain:How will you handle destructive behavior (e.g. chewing, digging)?How much do you think that you will spend MONTHLY for your pet? (for food, toys, etc...)$25-$50$50-$100$100-$200$200 or moreHow much do you think you will spend on a YEARLY basis for veterinary care for your pet?$50-$100$100-$250$250-$500$500 or moreAre you anticipating any changes in your household in the next 6 months? (check all that apply) None Baby / additional children Addtional pet(s) New/departing family member Other What would you do with your pet if you had to move?When could a representative contact you after the adoption to check on your pet's well-being?**Please contact your vet to: 1) Request your vet records to be faxed or emailed 2) Give them permission for Michigan Anti-Cruelty Society to discuss your previous pet(s) vet records with them within 3 days of submission of this application. I/We acknowledge that the information contained in this application is true & correct. Furthermore, any falsification of information may result in denial of your application. I/We understand that completion of this application does not guarantee adoption of the animal. By typing your name(s) below, this will act as your electronic signature. Applicant Electronic Signature* First Last Date* Co-Applicant Electronic Signature First Last Date PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.