Adoption Application

Personal Information

First Name:*

Middle Initial:

Last Name:*

Address:*

City:*

State:* Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:*

 Please Include area code with Phone Numbers

Home:*

Work:

Fax:

E-Mail:

How long have you lived at the present address? (if less then 5 years please give us previous address)

 Previous Mailing Address

Address:

City:

State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Date of Birth:

Drivers License No. (with State):

General Information

(Type <br> at the end of all lines before hitting enter to separate lines)
Names and relation of other adults in household:
         

Names and ages of children living in household on a regular basis:
         

Names and ages of children visiting household on a regular basis:
         

Additional Information

Do you currently own dog(s)? No Yes       
          How many?

Breed, sex, whether spayed/neutered, and ages of dogs owned:
         

Do you currently own any other type of pets? No Yes
          How many?

What kind of pets do you currently own?

Please let us know about any preferences you may have:

Gender of dog: Either Female Male Age preference: No Preference Puppy Young Dog Older Dog Color preference: No Preference Apricot Brindle Fawn

Type of home? Apartment/Condo Townhouse Trailer Single Family Farm Other (please elaborate) Other details:

Status of home? Own Rent Other  Other details:

How large is your yard?

Is your yard fenced? Yes No

Type of fence & height:

Where will the Mastiff live? Inside Outside Kennel Other (please specify) Other:

How many hours a day will you spend with the Mastiff?

Where will the Mastiff be kept when you are home?

Where will the Mastiff be kept when it is alone?

Where will the Mastiff sleep at night?

How will the Mastiff be cared for on overnight absences or while on vacation?

Have you ever owned a giant breed of dog before? No Yes
          Breed:

What happened to previous dogs? Non-Applicable Ran Away Stolen Sold Given Away (please elaborate) Given Up to Rescue or Shelter (please elaborate) Euthanized (please elaborate) Died (please give cause of death/age)
          Elaboration:
          

Name of the primary caregiver of the Mastiff:

How many dogs can you legally have where you live?

Is there a leash law? Yes No

What made you choose the Mastiff breed?
         

What made you decide to adopt a Mastiff from a Rescue Organization?
          

Please list your current veterinarian: (Name, clinic name, address, city/state/zip, phone & fax)
          

Other Information

Please list a personal reference who is not related to you: (Name, address, city/state/zip, phone, relationship)
          

Please list any other information/comments you feel may help us in placing a Mastiff in your home:
          

I certify that the information contained in this application is true and correct and I understand that prior to the placement of a Rescue Mastiff in my home, the information will be verified. I also agree to a personal interview to determine the suitability of my facilities to care for a Rescue Mastiff. I understand that UPON PLACEMENT of a rescued mastiff in my home that there is a donation of up to $500.00

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Type your initials & date here if you have read and understand the above statement:

Initials:*                                     Date (mm/dd/yyyy):*

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If you are interested in being a volunteer for Friends of Rescued Mastiffs, please go to our Volunteer Section.

Please be advised that we are all volunteers involved with identifying an receiving rescue Mastiff from shelters, picking up owner surrenders, conducting home visits, coordinating foster homes, transporting rescued Mastiffs for veterinary care and to new homes. If you have not heard from a representative within a month of the submission of this application, please feel free to contact us.

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Friends of Rescued Mastiffs - All rights reserved.
Revised 9/2005