MASA Adoption Application

Personal Info

Name

Please provide at least one contact number .

Home number

Cell number

Can we Text?

Yes No

Street Address

City

State

Zip Code

Name of Animal Interested in Adopting

Family & Housing.

How many adults are in your home?

How many kids? What are their ages?
Type "none" if no kids.

What type of home? (House, Apartment, etc.)

Do you Rent or Own?

If you rent, do you have permission from your landlord to have pets?

Yes No

Have you ever had Parvo in your home or yard?

Yes No

If yes, how long ago?

Anyone in your home have allergies to dogs or cats?

Yes No

Is everyone in agreement with the decision to adopt a pet?

Yes No

In the event that you have to move to a new home or move out of town, will you take your new pet with you?

Yes No

Do you have time to provide adequate love and attention?

Yes No

Do you have other pets? (Please specify type, age, male/female)

Are your pets spayed or neutered?

Yes No

If not, Why?

All pets up to date on vaccines?

Yes No

If not, Why?

Have you ever surrendered a pet to a shelter or rescued group?

Yes No

If yes, Why?

Have you ever had a pet Euthanized (put to sleep)?

Yes No

If yes, Why?

Has a pet of yours ever gone missing?

Yes No

If yes, How? DId you get that pet back?

Family & Housing Cont...

Where will you keep the new pet?

Inside Outside Both

What type of fence do you have?

Picket/Wood Cinder Block/Cement Chain Link No Fence

If no fence, how will you keep dog from escaping?

WIll you return the dog to MASA if you can no longer keep the dog?

Yes No

Are you willing to let a representative of MASA visit your home by appointment?

Yes No

MASA is a foster based rescue. Each and every one of our animals is rescued and stays in a foster/temporary home until it gets adopted. The more foster homes we have, the more animals we save!

Would you be interested in Fostering?

Yes No Maybe

How did you hear about MASA?

Facebook Adoption Event Friend Other

Veterinarian

Do you agree to provide regular health care by a licensed Veterinarian?

Yes No

Do you have a regular Veterinarian? Name the Clinic/Veterinarian.

(Providing MASA with this information, you are allowing MASA to call your vet if we feel it's needed. Please call your vet and ask them to authorize the release of information to MASA.).

Personal Reference

Name

Phone Number

Street Address

City

State

Zip

Relationship

Terms & Agreements

***To adopt, you must be at lease 18 years old, have the knowledge and consent of all adults living in your home and be willing and able to spend the time/money needed to provide the dog with training, vet treatment and proper care. We reserve the right to approve or deny any adoption. Every MASA animal has been vetted and cleared for adoption by a licensed Veterinarian. This does not guarantee that every animal is 100% healthy as conditions may show up after adoption and MASA is not responsible for any further veterinarian bills, unless otherwise agreed. MASA is not responsible if the animal you adopt bites other animal or human. Proper introduction, training, discipline and exercise can help avoid bad behaviors. If you decide that you can no longer provide a home for this animal you are required to release it back to MASA. Adoption fees are considered donations, and are not refundable or transferrable

I agree to allow a MASA representative to contact me by phone, text or email for updates on the dog. In the event that I move or change my phone number, I will contact MASA to update my information.

I agree to allow MASA to post my adoption pictures to it's Facebook page and/or Website

All informatrion I have given is true and complete. This dog will reside in my home as a pet. I will provide quality dog food, plenty of fresh water, indoor/outdoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.

Online Signature

Security code

Personal Info

Family & Housing.

Family & Housing Cont...

Veterinarian

Personal Reference

Terms & Agreements

Adoption and Foster Applications