Adopt a Dog Form

Adopt a Dog

Name of Animal or Breed Requested: 

How did you hear about this pet? 

APPLICANT INFORMATION:

First Name:     Last Name: 

Physical Address: 

City:     State:     Zip: 

Cell Phone:     Home Phone:     Work Phone: 

Email address: 

I am a: Renter   Homeowner

If applicable, Landlord’s Name:     Phone Number: 

 

Please note that some landlords may have breed restrictions due to insurance requirements or weight restrictions.

 

How many adults are there in your household?

Do children live in your home/visit your home regularly? Yes   No

If yes, how many?     What are their ages?

Do you have any other animals in your household? Yes   No

If yes, what type/age?     How many?

Are they up to date on vaccinations? Yes   No

If there are existing dogs in the household, we require that your existing dog meet your potential new dog prior to the completion of the adoption to ensure the best possible chance of a permanent, successful placement.

If no companion animals at the time, have you had animals in the past? Yes   No

Please tell us about them.

Where will your new dog sleep?

Where will your dog stay while you are not home?

How many hours per day will your new dog be home alone?

Do you have a fenced yard? Yes   No

Are you willing and able to provide the necessary level of exercise and training for your new dog? Yes   No

Would you like information on basic training and acclimation? Yes   No

Many shelter dogs will require an adjustment period to a new home and may need additional training. MTAS is happy to provide training information to you.

MTAS recommends the proper use of a crate to ensure training success. Please ask one of our staff or volunteers for information on crate training if you are unfamiliar with this method of training.

Are animal allergies a concern with family or regular visitors? Yes   No

Is everyone in the household in favor of adopting this animal? Yes   No

Have you considered the costs of pet ownership and are you willing and able to provide the animal with the necessary care and medical support? Yes   No

 

 

VETERINARY REFERENCE:

 

 

Name: 

Phone Number: 

 

 

OTHER ANIMAL CARE REFERENCES (not a family member): MUST PROVIDE AT LEAST ONE; 2 REFERENCES NEEDED IF NO VET REFERENCE

 

 

Name: 

Phone Number: 

Name: 

Phone Number: 

 

 

BY CHECKING THE CHECKBOX BELOW:

 

 

  • You are giving the Montclair Township Animal Shelter permission to use the information in this application to contact all references, veterinarians, and landlords listed.
  • You certify that the information you provided us on the form is accurate and truthful.
  • You understand that this is an application and does not guarantee that any particular companion animal will be adopted out to you and that the Montclair Township Animal Shelter has the right to deny applications if they feel the home is not a good match for an animal.

Check to Agree  Date: 



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