I - About You:

Todays date    

*Your last name    

*Your first name    

Spouse's last name    

Spouse's first name    

*Home phone (with area code)    

Best time to call (home)    

Work phone (with area code)    

Best time to call (work)   

*Your street address    



*Zip code    

Major cross streets    

Email address   

Your occupation    

Spouse's occupation    

Personal reference (include name and phone number)    

Type of animal I am interested in adopting    

I saw a specific animal I'm interested in     Yes    No   

Animal's name    

I saw the animal at    

I spoke with    

II - About Your Household:

*How many children in household?    

Age and sex of children    

*Do you currently have other pets?     Yes    No   

Please list the type and ages of all current pets in your household.
Please include breed, sex, age and whether or not your current pets are either spayed or neutered.   

Are there other animals or people who regularly visit your home? (i.e., Mother’s dog, neighborhood children, relatives, etc)    Yes    No   

If yes, describe:   

Are all household members in complete agreement to adopting, caring for, and training a new pet?     Yes    No   

Do any family members have allergies to pets?    Yes    No   

As an animal owner, I consider myself:     Experienced    Somewhat experienced    Novice   

When would be a good time for us to come for a home visit?   

III - About Your Home:

What type of home do you live in?    

How long have you lived at your present address?   

If less than one year, give previous address:   

Do you own your home, or do you rent?    Own    Rent   

If you rent, do you have permission from your landlord to keep a dog or cat?
If yes, we will need a copy of written permission.    
Yes    No    N/A   

Your landlord’s name and phone number:   

May we have permission to contact your landlord?    Yes    No    N/A   

Do you have a doggie door?    Yes    No   

Is your yard fenced?    Yes    No   

Please describe your fencing. (height/material)   

Does it completely enclose a yard for dog?     Yes    No   

Do you have acreage?    Yes    No   

Do you have a separate kennel run?    Yes    No   

Kennel height and dimensions?   

Do you have a swimming pool or spa?    Yes    No   

Is it fenced?    Yes    No    N/A   

What is the type of fencing?   

Are you aware that most dogs enjoy swimming and
if you have an unfenced pool a dog will most likely swim in it?   
Yes    No   

IV - Your Experiences with Pets:

If you do not currently have a pet, have you owned a pet before?    Yes    No   

What breeds?   

What happened to your previous pets?   

Have you ever had to relinquish an animal?     Yes    No   

What were the circumstances?   

Under what circumstances would you ever relinquish an animal?   

Have you ever bred an animal?    Yes    No   

Have you read any books or articles on the type of pet you want to adopt?    Yes    No   

Why are you interested in this particular breed?   

If you have current pets, or have owned a pet before, may we contact your preferred veterinarian?     Yes    No    N/A   

Veterinarian’s name and phone number:   

V - The Perfect Animal for You

What gender animal do you prefer?     Either    Male    Female   

What color / hair coat length do you prefer?    

What is your age preference?   


Would you be willing to adopt an animal that is a mix?    Yes    No   

Please check all of the following that apply.

I would like an animal that is:   
Playful with people Playful with dogs Moderately active Very active Quiet

It's ok if the animal is:    Not good with cats Not good with other dogs Dependent on people Independent from people
Untrained Somewhat untrained Not housetrained In need of ongoing medical attention
What do you expect in a companion animal?     Friendship Child's friend Appearance Protection Hunting
Obedience Agility Other

Please check which one of the following canine traits is most displeasing to you:    Drooling Odor Jumping on people
Barking Chewing Shedding Digging

Activity Indoors: Some animals are lively and curious in the house. They like to play with you and follow you around. Some animals lie down most of the time. Do you think an active pet will annoy you?     Yes    No   

What type of personality/activity level are you comfortable with in an animal?    

Would you be willing to adopt an animal with health problems?    Yes    No   

Would you be willing to adopt more than one pet?    Yes    No   

VI - Caring for Your New Pet

Who will become the primary caretaker of the animal?   

How long are you gone each day?    

Where will the animal sleep at night?   

Where will the animal be housed during the day when you are home?   

Where will the animal stay while you are gone during the day?   

How often do you travel?   

When you travel, where will the animal be boarded?   

How will you transport the animal in a vehicle?    

How will you exercise the animal?    Daily walks Tennis ball play Jogging Swimming Hiking Run free Other

How much responsibility will your child or children be given in the care and management of the animal?    



Household and social behavior    


Obedience training    

How much adult supervision of animal and child will be provided?    

With neighborhood children?    

How much have you budgeted for the total yearly expenses for your animal (food, vet, etc.)?    $

If your pet swallowed a sock and the veterinarian told you it needed an operation that would cost $1200, what would you do?    

Do you agree to contact ARC if you can no longer keep this animal?    Yes    No   

VII - Training Your Dog

Will you agree to take the animal to obedience classes if recommended by the adoption coordinator?    Yes    No   

Have you ever completed an obedience class with a previously owned dog or current dog?    Yes    No   

If yes, what were the training techniques you learned?   

Do you understand that some of the rescues will come with minimal training and may need a large amount of patience?    Yes    No   

Are you agreeable to crate training?    Yes    No   

If not, why?   

VIII - Other Items

Would you like to become involved in Animal Rescue or care?    Yes    No   

Would you like to be a Foster Family for an animal in need? (A foster family is a temporary home to a rescued animal until the animal can be placed with a permanent family)    Yes    No   

How did you hear about us?   

Why do you want to adopt a pet?


Use the space below for any additional comments:   

General Agreement

I am at least 18 years of age. All of the information I have given above is true and complete. Should an unaltered animal be placed with me, I agree to have it neutered within one month of adoption or the date agreed upon in the Terms of Adoption Contract signed at the time of Adoption. This animal will reside in my home as a pet. I will provide it with adequate food, water, shelter, training, affection, and medical care. I understand that ARC is a referral service and is not responsible for the accuracy of information received about the temperament, habits, or physical condition of animals available for adoption. I understand that it is my responsibility to see and evaluate the animal for myself before agreeing to adopt it. I acknowledge that there are many risks associated with being around animals, including the risks of being bitten, scratched, jumped upon, knocked over, chased, tripped, infected with a disease, injured, or frightened, and I voluntarily assume such risks on behalf of myself, my children, and my guests. Despite my knowledge of these risks, and despite the fact that I understand that these risks might arise out of the negligent handling of animals by ARC, its members, directors, or officers, I have voluntarily agreed to participate in the ARC adoption program, and fully accept the risks that go along with that participation. With these risks in mind, I agree to waive, release, and covenant not to sue over any and all rights or claims for damages which I or my heirs may have against ARC, its members, directors, and officers, arising from any property damage or personal injury which I, my children, or my guests might sustain as a result of participating in the adoption process, even though such rights or claims might arise out of the negligence of ARC, its members, directors, or officers. This waiver is binding upon myself, my children, and my guests. I agree to inform my guests of the existence and contents of this waiver. I hereby grant ARC the right of first refusal for any dog I adopt through ARC. I will not relinquish ownership, abandon, or dispose of such a dog in any way without first contacting The Jejune Institute and allowing the organization the opportunity to exercise its right of first refusal. In exercising its right of first refusal, I agree that ARC may repurchase the animal from me for the price I paid ARC for the animal, not including the portion of the adoption fee that represents a charitable contribution.

By submitting this electronic/online application, I am indicating that I am in full agreement with these terms of adoption.

Thank you for your interest in Moonlight Menagerie. We appreciate the time it took to fill out this application.