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Name: Address: Home Phone: Work Phone: Cell Phone: Residence: Owned Rental Other If "Other" Explain... Do you have proof of residency in AZ? Yes No License#: If renting, do you have written permission to own a pet?: Yes No What is your landlords name & phone number? What is your primary reason for wanting to adopt a pet? Is this your first pet?: If you have pets, have they been neutered or spayed: How many pets do you presently have? What Species?: Will your pet(s) adjust to a new dog in the house?: Veterinarian reference and Phone: Does anyone in the family have allergies to animals?: Do you have a fenced in yard?: Height & Material of Fence: Is there an outside gate?: Is it locked at all times?: How many hours per day will the pet be inside your home?: Breed, size, type & age of pet wanted?: Have you ever been convicted of animal cruelty or neglect?: How many adults are in your family?: How many adults are in your Children?: What are the ages your Children?: How often will the pet be left alone?: Length of time?: Will the pet be left inside your home when left alone?: Will you be financially able to provide veterinary care for the pet?: If you go on vacation or are away for a few days, who will take care of your pet?: Can you guarantee a permanent home for this pet?: Do you own/drive a pickup truck??: Would you allow the pet to ride in the back of it?: Are you willing for representatives of MM&F to do a home check?: Are you able and willing to excercise your pet?: Where will the pet be kept during the day?: Where will the pet be kept during the night?: Will you allow a MM&F representative to visit your home as a follow-up visit?: I understand, and agree that MM&F reserves the right to decline any application for any reason: Comments or Questions:
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