Dog
Most Interested:
First
Name:
Last Name:
Address:
City:
State,
Zip Code:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Phone
(Home):
Phone
(Cell):
Email
Address:
Children
- How many? Ages?
Total
number of people in household (roommates, etc):
Please
list members of household and relationship to you (roommates,
husband, mother etc):
Do
you Own or Rent your home?
Own
Rent
If
renting, does lease allow dogs?
Yes
No
N/A
Fenced
yard?
Yes
No
Home
Location:
Rural
Urban
Suburban
Type
of Home:
Single Family
Townhouse
Apartment
Condo
How
long have you resided at current location?
Place
of employment (adults only) and how long employed there?
Any
plans to transfer to another location or change of employment?
How
many hours a day will your dog be left alone?
0 - 5 Hours
6 - 8 Hours
9 - 12 Hours
12 + Hours
Where
will your dog be kept while you are not home?
Outside
Crated
Free Roam of House
Enclosed Area
Basement
Other
Please
describe when/where you will walk/exercise the dog on leash?
List
all places where dog will be allowed to have off leash
exercise:
How
much time do you realistically have each day to exercise or
play with your dog
Who
will care for your dog while you are on vacation/travel
How
many weeks a year are you away from home on business or
vacation?
0 - 2 Weeks
3 - 4 Weeks
5 - 6 Weeks
7 + Weeks
How
will you encourage and reinforce appropriate behavior?
If
you have had a dog in the past, did you ever have to deal with
any behavioral issues (housebreaking, chewing, separation
anxiety)? if so, please list the issue's) you have
encountered/dealt with.
How
will you prevent/manage inappropriate behavior?
What
do you foresee as normal dog problems?
Will
your dog ever be left outside unattended when you are not
home?
Sometimes
Always
When Weather is Nice
Never
What
will you do with your dog if you have to move?
Find a New Home
for the Dog
Take Dog on Move
Take to Local
Animal Shelter
Return to
Mutts Matter Rescue
Who
will be primary caretaker of the dog?
What
size dog will appeal to you most when it's fully grown?
Tiny (0 - 8 lbs)
Small (10 - 20 lbs)
Medium (25 - 50 lbs)
Large (50 + lbs)
Does
anyone in your household have allergies to animals/dander? If
yes, please explain
Where
will your dog sleep?
What
type of monthly heartworm and flea preventative will you
provide each month?
Please
check all that apply... I would considering giving my dog back
to MMR:
if
my work schedule changes dramatically and I no longer have
sufficient time for the dog
if
I have children in the future and no longer have sufficient
time for the dog because of the demands of parenting
if
other changed circumstances prohibit me from having sufficient
time with the dog
if
someone in the household becomes allergic
if
I become ill and can no longer take care of the dog
if
I lose my job
if
i divorce or separate from my spouse/partner
if
my new significant other does not like the dog
if
dogs sheds excessively
if
the dog is not housebroken
if
the dog is or becomes aggressive
other
If
other, please explain
Have
you ever owned a dog/cat/other pet? (do not include family
pets from childhood)
Yes
No
If
yes, please list past and current pets
Was
your pet spayed or neutered?
Yes
No
Where
did you get pet from?
Please
list your Vet Hospital, Dr's Name and Phone #
Please
list an additional reference (name and phone #) of someone
that is not related to you that we may call.
Have
you ever had to give up a pet for any reason? If yes, what
happened to the pet?
Will
you permit a home visit by a MMR representative?
Yes
No
Please
use the space below for any additional comments you would like
to make to Mutts Matter: