More than 5,500 Adoptions

Since 1988. . . and still counting!

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    Name
    Address
    City
    State
    Zip
    Home Phone
    Cell Phone
    Occupation
    Employer
    Employer Address
    Employer Phone
    Age of the Applicant:
    If over 75, please list age
    1. How did you hear about our adoption program? If from a friend/relative, please name.
    2. Why do you want to adopt a dog?
    3. What other pets do you have now? Please list breed of dog, sex, age, and if spayed/neutered
    4. Approximately how many hours a day do you work outside the home? Please figure in commuting time.
    5. Are there children in the household?
    Please list ages and sex:
    5a. Are there grandchildren/relatives or friends’ children who visit frequently?
    6. Dwelling Type
    7. Do you own your own home:
    7a. If no, do you have landlord’s permission to have a dog?
    YesNoN/A
    If yes, please list his/her name and phone number:
    8. Do you have a fully fenced area attached to your home?
    8a. What type of fencing? 8b. What height?
    9. If not, is there a fenced area nearby where you can exercise your dog once or twice a week?
    YesNoN/A
    10 Where do you intend to house your dog?
    11. How often are you willing to take your dog outside to relieve himself?
    12. Do you intend to keep your dog on a leash when outdoors unless in a fenced area?
    13. Please provide us with the name, address and phone number of all veterinarians who know you or have treated your animals. Please list the name and type of animal and the years in your care.
    I hereby give my permission to release all veterinary information to a Make Peace With Animals Representative regarding the care I give my animal(s). I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT.

    Make Peace With Your Self
        Make Peace With Each Other
           Make Peace With Animals