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Adoption Application

Thank you for your interest in adopting a furry friend from SCMR. We are committed to finding loving and permanent homes for our dogs. Please fill out the adoption application below, and we will get back to you as soon as possible.

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Adoption Application

SCMR policy is that we do not adopt to households with children 10 or under and SCMR does not adopt to homes with electric fences.

It is important to be sure the entire application is filled out correctly and completely. If any questions are not completed, the application with not be processed.

Having read this notice, I acknowledge I understand these policies.

Full Name:

Applicant age:

Phone:

Address:

City:

State:

Zip:

Email:

Occupation

How long have you been at this address?

Are you interested in a particular dog?

Yes

If Yes, please list the names of all dogs that you are interested in:

If No, up to what size?

If No, what breed(s) are your interested in?

Gender preference

Male

Female

Either

Will you accept a Mix?

Yes

Do you own or rent?

Own

Rent

If you Rent, Do you have the permission of your landlord to have a dog?

Yes

If you answered yes, please provide the name, address, and phone number of the landlord, since permission to have a dog in your home will be required in order to be approved to adopt:

SCMR will adopt a rescue that is out of state to the applicant, but does not ship or transport them, we ask the approved adopters to make those arrangements. If the rescue being asked about is out of state, are you willing to make the drive to pick them up, no matter how far they are?

Yes

Would you consider a Special-Needs Rescue Animal such as one who requires medication for a permanent but controlled condition?

Yes

Please tell us why you want a Dog:

Please tell us a little about your lifestyle, your family, including any special activities in which your dog would be included. (If you have any special requirements or requests for a dog, please let us know so that we can more carefully match a dog to your lifestyle.):

Do you have any children, currently expecting a child or planning for a child? (Please note: SCMR policy is that we do not adopt to households with children 10 or under.)

Please provide the information below as to who lives in the home, giving names, ages and relationship:

Resident #1 (name, age, relationship:)

Resident #2 (name, age, relationship:)

Resident #3 (name, age, relationship):

Resident #4 (name, age, relationship):

Resident #5 (name, age, relationship):

Please let us know who else lives in your home, their age, and do they share your interest in adopting a dog?

Who is the dog primarily for?

Adult

Child

Elderly

Physically Challenged

Who will care for, train and exercise the dog?

Does anyone in your household have allergies to dogs?

Yes

Please list all the pets you have owned, what kind, sex, spay/neutered, and what happened to the pet.

Do you currently have other animals?

Yes

If yes, please list type of animal, age, and sex, and if spayed/neutered:

Have they ever been around other animals?

Yes

Do they get along with other animals?

Yes

Do your pets have any characteristics that we should be aware of that would affect an animal coming into the home (i.e., is your pet aggressive toward other animals, etc.)?

Yes

If Yes, please describe the characteristic(s):

Where will the dog be during the day?

Will someone be home during the day?

Yes

How many hours will this pet be alone during the day?

Where will the dog be at night?

Is your yard fenced in? (SCMR does not adopt to homes with Electric Fences)

Yes

If Yes, what type and height?

If No, please describe how you plan to confine your dog to your property when outside:

Southern Comfort Maltese Rescue policy regarding adopting to homes that have a swimming pool: SCMR will make exceptions for homes that have swimming pools provided the applicant can assure the rescue will be safe from any danger of getting into the pool. Please provide the following information:

Do you have a swimming pool? (If No, please go to next section)

Yes (In ground)

Yes (Above ground)

Is there a fence, secured around the entire pool (not just the yard) that would prevent pets from getting too close and falling in?

Yes

If yes, please describe the type of fence and height:

If no, please provide the information if willing to provide an alert system (for example: a K9 Safety Turtle device) that would signal an alarm in case a pet fell in the pool:

Alert system:

Are you willing to obtain a crate and crate-train your dog if necessary?

Yes

Where will the dog stay when you are on vacation or out-of-town?

If you move, what will you do with your dog?

What behaviors would cause you to give up your dog?

Do you have a current or previous vet?

Yes

Please provide the name of your current (or previous, if no current) veterinarian and the full name, address, and phone number of his/her vet clinic and IF WE MAY CONTACT YOUR VET FOR A REFERENCE. We also request you contact your veterinarian's office to let them know SCMR will be calling, giving them permission to talk to us at that time.

Please provide the full names, addresses, and phone numbers of 3 personal references that are NOT relatives:

If you do adopt a rescue dog and decide to give it up, do you agree to contact us and make arrangements to get the dog back to SCMR?

Yes

Have you or any members of your family/household been cited for leash law violations or cruelty to animals in the past? If Yes, please specify:

Have you applied to any other Rescue groups? If yes, please identify the group so that we do not duplicate their efforts:

I/We attest that the Terms and Conditions of Adoption as stated below have been read in full by me/us and I/we understand that is part of the adoption process and will be enforced.

I/We attest that the information provided on this application is true and accurate to the best of my/our knowledge.

I/We attest that we have retained a copy of the Terms and Conditions of Adoption and also understand that completion and submission of this application does not guarantee adoption of a Rescue Animal.

I/We understand that any misrepresentation of fact may result in the removal of the adopted dog from my/our home.

I/We understand that if this application was submitted via email, formal signature(s) will be obtained when and if adoption takes place.

I agree

Your Signature

Co-Applicant Signature

Today's Date:

Add your name

This Agreement may be executed in one or more counterparts, each of which will be deemed to be an original copy of this Agreement and all of which, when taken together, will be deemed to constitute one and the same Agreement. The exchange of copies of this Agreement and of signature pages by facsimile or other electronic transmission shall constitute effective execution and delivery of this Agreement and may be used in lieu of the original Agreement for all purposes. Signatures of the parties transmitted by facsimile or other electronic transmission shall be deemed to be their original signatures for all purposes.

Thank you! Your form has been submitted.

Adoption Application

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