Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Primary Phone *

(###)

###

####

Alternate Phone

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you own or rent your home? *

Own

Rent

Do you have a fenced yard? *

Yes

No

Is anyone in the home allergic to dogs? *

Yes

No

Do you currently have other pets?

Yes

No

Have you had dogs in the past? *

Yes

No

Have you ever surrendered a pet or had one rehomed? *

Yes

No

Preferred dog size: *

Small (under 25 lbs)

Medium (25-50 lbs)

Large (50+ lbs)

No preference, open to any size

Preferred age for your dog: *

Puppy

Young Adult

Adult

Senior

No preference

Energy level preference: *

Low

Moderate

High

Gender preference *

Male

Female

No preference

How do you plan to exercise the dog? *

Please select all that apply.

Walks

Fenced yard play

Dogpark

Doggy daycare

Other

What behaviors would cause you to return a dog? *

Excessive barking

Chewing

Agression

Housetraining issues

Other

Are you willing to enroll in training if recommended? *

Yes

No

Are you financially prepared for unexpected vet bills? ($1000+) *

Yes

No

By typing your FULL NAME in the box below, you are stating that you have read and agree to the following: *

- I certify that all information provided is true and complete. - I understand that submitting this application does not guarantee adoption. - I authorize Minoli Foundation Animal Refuge to contact landlords, veterinarians, and references. - I am prepared to provide a loving, safe, and lifelong home for a rescue dog.

First Name

Last Name

Date of signed application *

MM

DD

YYYY