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: