1B_Test

Missing required fields!

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Animal Interested In
Name
Where did you see them?	At Shelter MACS website Pet Smart Petfinder Adopt-A-Pet Facebook TV/Radio/Newspaper Other
If other, please explain.
What age group are you looking for?	Under 1yr 1-3yrs 3-5yrs 5-8yrs 8+yrs
Applicant Information
First Name *
Last Name *
Address *
Apt / Unit #
City *
State *
Zip Code *
Cell Phone *
Home Phone
Email *
Are you employed? *
Drivers License / State ID # *
How long have you lived at this address? *
What type of home do you live in? *
If other, please explain.
Do you *
If other, please explain.
Household Information
How many adults living in the home?
How many children in the home?
What are their ages?
Does everyone know you are adopting a dog? *
Who will be the primary caregiver of your new pet? *
Who will take care of your pet(s) when you go on a vacation? *
Where will the pet be kept when they are left home alone? *
Where will the pet be kept while you are sleeping? *
Pet History
Have you ever owned a dog before? *
When was the last time you owned a pet?
Have you ever adopted from this or any other shelter or rescue?
Have you ever surrendered a pet to this or any other organization? *
List all the pets you have owned in the last 5 years, alive or deceased
Pet #1
Name?
Species / Breed?
Age?
Sex?
Sterilized?
Alive?
If deceased, please explain what happened.
Add another?
Pet #2
Name?
Species / Breed?
Age?
Sex?
Sterilized?
Alive?
If deceased, please explain
Add another?
Pet #3
Name?
Species / Breed?
Age?
Sterilized?
Sex?
Alive?
If deceased, please explain.
Add another?
Pet #4
Name?
Species / Breed?
Age?
Sex?
Sterilized?
Alive?
ceased, please explain.
Add another?
Pet #5
Name?
Species / Breed?
Age?
Sex?
Sterilized?
Alive?
If deceased, please explain
Veterinarian
Veterinarian’s Name
Veterinarian’s phone
Who’s name are the vet records in?
Veterinarian Records Acknowlwedgement Please check this field to acknowledge that YOU must contact your veterianarian in order to arrange your current or past pet records to be sent to or be discussed with the Michigan Anti-Cruelty Society. Veterinarians will not release or discuss these reocrds without the owner’s permission.
*	I Agree / I Acknowledge

Tell us more about you
Yearly Vet care How much do you think you will spend YEARLY basis for veterinary care for your pet?	$50-$100 $100-$250 $250-$500 $500 or more
Moving * What would you do with your pet if you had to move?
Post adoption When could a representative from the Michigan Anti-Cruelty Society contact you after the adoption to check on your pets well-being?
Why do you want to adopt a dog?	Guard / Watch Dog Companion Hunting Dog Breeder Gift
I am adopting this dog for:	Myself My Family My Children A Relative Companion for another pet
What type of yard do you have?	No Yard Partially Fenced Completely Fenced Unfenced Yard Dog Run Tie Out Underground / Invisible Fence Other
If Other, please explain
Please contact your verterinarian and have them email us a copy of your pet’s vaccine history to [email protected] within 2 business days of submission of this application I acknowledge that the information provided in this application is true and accurate. Furthermore, any falsification of any information provided may result in the denial of your application. I also understand that the completion of this application does not guarantee adoption of the animal.
Signature * Please sign.

Dog Application

Animal Interested In

Applicant Information

Household Information

Pet History

Veterinarian

Tell us more about you