Adoption Application If you are interested in adopting one of our animals in the rescue, please fill out the adoption application form below. *Our Rescue adoption fee ranges between $150-$500, depending on the animals current age, and conditions. Adoption Form Step 1 of 4 25% What type animal are you looking to adopt?*Select OptionDogCatOtherPlease provide the animal(s) name you are interested in adopting?*Your Full Name* First Last Date of Birth* Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Number*Email Address* Please list the members of your household:*NameAgeRelationship to me Do you own or rent your home?*select optionOwnRentN/AIf you rent, please provide your landlord's information here:*NamePhone #Email Address Have you ever owned a pet before?*Select OptionYesNoDo you own any pets currently?*Select OptionYesNoPlease provide information on your current pets. (FAILURE TO ANSWER ALL THE QUESTIONS BELOW, WILL RESULT IN YOUR APPLICATION NOT BEING ACCEPTED!)*NameBreed (CAT/DOG)AgeGenderSpayed or Neutered?(YES/NO)Up to Date on vaccines?(YES/NO)On monthly Heartworm Prevention? (YES/NO) Have you ever adopted before?*Select OptionNoYesWhere have you adopted from before?*Do you have a yard?*Select OptionNoYesIf yes to owning a yard, is the yard fenced?*Select OptionNoYesHave you ever surrendered a pet you owned before?*Select OptionYesNoex: to a shelter or to another person.If yes to surrendering your pet, please explain why below.*How many hours per day would the pet be alone?*Will you crate your pet?*Select OptionNoYesIf you have to leave town, urgently or planned, where would your pet stay?*How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?* Please provide your vet references below:*NamePhone NumberEmail Address Please provide three personal references below:*NamePhone NumberEmail Address Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*Select OptionNoYesPlease read, and agree to the terms, and conditions below.* I agree to the terms, and conditions.-By clicking the submit button, I agree to Mutty Paws Rescue Inc. adoption process, will undergo a home-check, and interview at the discretion of Mutty Paws Rescue Inc. -By clicking the submit button, I understand Mutty Paws Rescue Inc. will check my references including veterinary and personal. -By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from Mutty Paws Rescue Inc. and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet and therefore , adoption donations and deposits are non refundable. -By clicking the submit button, I agree to identify, and hold harmless Mutty Paws Rescue Inc. against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed. -By clicking the submit button, I understand that Mutty Paws Rescue Inc. will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed. -By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet back to Mutty Paws Rescue Inc. and provide transport to where Mutty Paws Rescue Inc. deems appropriate. -By clicking the submit button, I verify all of the above information is true and accurate. Signature*