Mariah's Promise

Name of Pet you are applying for:

YOUR PERSONAL INFORMATION:
Your Name:
Your Spouse's or Significant Other Name (if any):
Address:
City:
State, Zip:
Home Phone:
Cell Phone, if any:
Work Phone, if any:
Email Address:
Your Age:
Your Spouse's or Significant Other's Age:
How many other adults live in your home?
What are their ages, if appl.?
Do you have any children living in your home or visiting your home on a regular basis?
If YES, what are their ages?
If NO, do you expect that to change in the near future?
Does anyone in your home have allergies?
If YES, please explain:

HOME INFORMATION
What type of home do you live in?
Do you own or rent?
If you rent, do you have landlord permission to have a pet?
If you rent, please provide your landlord's name and phone number:
Do you have a securely fenced yard?
What type of fence do you have?
If other, please explain:
What is the height of your fence at the lowest point?
Will you consent to a home inspection by one of our volunteers?
Do you have plans to move in the near future?:

PET CARE INFORMATION
How many hours per day will this adopted dog be left alone:
Where will this adopted dog stay during the day?
Where will this adopted dog stay during the evening?
Where will this adopted dog sleep?
If this adopted dog is not housebroken, how will you manage this?
Are you willing to crate train this adopted dog, if necessary?
Are you willing to attend dog obedient classes, if necessary?
Are you prepared and willing to take care of this adopted dog's needs for his or her natural lifetime?
Do you have the financial resources to pay for any and all veterinary medical costs for this adopted dog?
Do you have a limit of how much you are willing to spend?
If YES, what is that limit?
If or When you go on vacation, where will this adopted dog stay?
If you are unable to keep this adopted dog for any reason, what will you do with this dog?
Under what circumstances would you ever give a dog up?
Have you ever given a pet to a animal shelter, humane society, or rescue organization?
If YES, what was the reason for giving that pet up?

CURRENT / PREVIOUS PETS

Do you currently have any pets living in your home?

If YES, please describe: Species (dog, cat, bird, etc.); Breed; Age; Sex; Spayed/Neutered

Current Pet #1:
Current Pet #2:
Current Pet #3:
Current Pet #4:
Current Pet #5:

Please use the comment section at the bottom of this application for any additional current pets.

Have you had any pets in the past (as an adult)?

If YES, please describe: Species (dog, cat, bird, etc.); Breed; Last Known Age; Sex; Spayed/Neutered; What happened to that pet?

Past Pet #1:
Past Pet #2:
Past Pet #3:
Past Pet #4:
Past Pet #5:

Please use the comment section at the bottom of this application for any additional past pets.

Do you currently have a Vet?
If YES, please provide the Vet's name and phone number:
If NO, please provide your Vet's name and phone number that you had in the past. If none, enter None.

Is there any additional information that you would like to provide that would help in consideration of approving your application?

Any additional comments or questions, and additional pet information from above:

By submitting this application to Mariah's Promise, I certify that the information is true and accurate to the best of my knowledge and that I understand that providing any false information can be cause for denial of my application or future forfeiture of the adopted pet. Leaving any questions blank or not filling out this form completely can be cause for the application to be discarded or denied.