Foster Application

PO Box 324

Rutland, VT 05702

802-776-8010

MapleLeafMutts@gmail.com

Thank you for considering a rescue dog! We strive to match the right dog with the right family, and so we require that this application be completed thoroughly. Being the first to apply for a particular dog does not guarantee that you will be selected to adopt the dog. Our goal is to place each dog into the home that is the best match for that particular dog. Thank you for your understanding. Incomplete applications cannot be processed.

I am interested in.....

What dog are you interested in?

What Volunteer Position are you interested in?

Your Name*

First NameLast Name

Your Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Best Number To Reach You*

Area CodePhone Number

Second Number You Can Be Reached

Area CodePhone Number

Email - confirm email in 2nd field*

Confirmation Emailexample@example.com

Occupation

Please list the NAMES and AGES of all adults (18 or older) who live in your home either full or part-time, including yourself:*

Please list the NAMES and AGES of all children (younger than 18) who live in your home full or part-time:*

Which ofthe following best describes your family life?

Calm and QuietActive and BusyVaries Day to Day

Which ofthe following best describes your home?

Explain "Other"

Do you own or rent your home?*

OwnRent

How many years have you lived at your current address? *

If you rent your home, please provide your landlord’s name and phone number with area code:

Does anyone living full or part-time in your home have allergies to pets of any kind? Who,and to what type of animals?*

Is this pet a surprise for anyone in your home?

YesNo

Explain "Yes"

Why would you like to adopt a dog?

Please list all pets that currently live with you. Include pet’s name, breed (if dog), age, neutered/spayed/intact, declawed, etc:*

Are your current pets up to date on all shots? We do require that all current pets be up to date on vaccines.

YesNo

If "No", Why not?

Are your current dogs on monthly heartworm preventative? We strongly prefer that current dogs be on heartworm preventative and tested annually.

YesNo

Brand of heatworm preventative?

If "No", Why not?

What other pets have you owned in the past 5 years, and where are they now? Include, name and breed (if dog). *

What do you think are the most important responsibilities in owning a dog?

Who will be primarily responsible for the care of the dog?

How much do you think it will cost to feed and provide veterinary care for your dog in a year?

What brand of dog food do you plan to feed your dog?

Where will your new dog spend its time when you are home?

Where will your new dog spend its time when no humans are home with it?

How many hours per day will your new dog be at home with no humans present?

Where will your new dog sleep at night?

Do you have a fenced in yard?

YesNo

If yes, is the fence fully enclosed?

YesNo

If yes, what kind of fence is it (height, and type of material such as chain link,picket, etc)?

If you do not have a fenced yard, please explain how your new dog will be given access outdoors (e.g. tied out, loose, aerial run, invisible fence, etc)

How do you plan to exercise your new dog, and how often?

Even housetrained dogs may have accidents when they move into their new home. What will you do if your new dog has an “accident” (or more than one) in your house?

Do you plan to crate train your new dog?

YesNo

If yes, please explain when and why the dog will be confined to the crate:

Have you ever participated in formal dog obedience training classes?

YesNo

Do you plan to participate in formal dog obedience training with your new dog?

YesNo

If Yes, Where?

If you are adopting a puppy, how will you housetrain it?

If you travel, what arrangements will you make for your dog?

When your dog goes with you in a vehicle,where will it ride?

Are your dogs currently licensed with your town/city?

YesNo

If you have or have had any pets in the last 5 years please provide the name, address and telephone number of the veterinarian who treats or treated them. Veterinarian’s Name:*

Business/Clinic Name*

Address and Phone Number*

Names of pets this Veterinarian has or does provide care for: *

Have you ever adopted a dog from a rescue or shelter before?

YesNo

If yes, which rescue or shelter?

Have you ever been denied adoption by any rescue or shelter before?*

YesNo

If yes, do you know why you were denied?

YesNo

If yes, please explain:

Have you ever surrendered an animal to arescue or shelter?*

YesNo

Explain if yes:

Have you ever given an animal away?*

NoYes

Explain if yes:

Have you ever had a pet euthanized?

NoYes

If yes, please explain:

Are you willing to allow a representative of Maple Leaf Mutts visit your home to see where the dog will live prior to adopting?*

YesNo

Are you financially able to afford medical care for health issues if they should arise either in the near future or when your dog ages?

YesNoNot sure

Please use the space below to add any information that you would like us to consider with regard to your adoption application:

Personal References (non-relatives) (Applications without phone numbers will be returned)

1. Name*

First NameLast Name

Phone Number*

Area CodePhone Number

How does this person know you? *

2. Name*

First NameLast Name

Phone Number*

Area CodePhone Number

How does this person know you?*

In submitting this application I represent that the information that I have provided is the truth to the best of my knowledge and belief. I authorize my landlord to release any and all information to a Maple Leaf Mutts representative, and also authorize my veterinarian to release any and all information to a Maple Leaf Mutts representative.

I am aware that the Maple Leaf Mutts adoption fee is $450 for puppies 10 months and younger, $350 for puppies older than 10 months and adult dogs and $250 for senior dogs, or unless otherwise stated. This fee helps defray the cost of vaccinations, microchipping, spaying/neutering, and any other vetting necessary for a healthy dog.

I further state that I have not been charged with or convicted of domestic violence, child abuse, and/or animal cruelty, nor has any person living full or part-time in my household been so charged and/or convicted.

By typing your name you agree this will be used as your signature.*

Maple Leaf Mutts Application