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/NewspaperWhat 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?*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 PhoneWork PhoneApplicant's Drivers License / State ID #*Email* Enter Email Confirm Email 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?Does anyone in the house have allergies to pets?*YesNoIf yes, what kind?Does everyone in the household know that you are adopting a dog?*YesNoWho will be the primary caregiver of the new pet?*Who will be the caregiver for the pet when you go on vacation?*Where 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?Please list your veterinarian's nameVet's PhoneIn whose name are the vet records in?How 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 moreWhat would you do with your dog if you had to move?When could a representative contact you after adoption to check on your dog's well-being?Why 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 Do you have a yard that is fenced?No yardPartially fencedCompletely fencedUnfenced yardDog runTie outUnderground/Invisible fence**Please contact your vet to them fax vaccine history to (313)891-8704 within 3 days of submission of this application.** I acknowledge that the information contained in this application is true & correct. Furthermore, any falsification of information may result in denial of your application. I understand that completion of this application does not guarantee adoption of the animal. SignatureTo sign your name, hold down the left mouse button while moving the mouse. For touch screens, you can use your finger or a stylus. NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.