Special Notice!
 

Help the animals by using this link to activate your card. All you have to do is pick up a card at Schnucks, activate it on-line, & present the card to the cashier when you check out. This program does not cost you a penny.
Do you shop at Schnucks?



Phoenix was rescued from dog fighting and now he needs your help. Midwest Dream Homes will be building Phoenix's cottage.
New life for blind pit

Adopting a Friend

Application must be 100% completed, please fill out ALL questions.

Use Tab Key To Move Through Application Questions

Your Full Name Age
Spouse Full Name Age
Full Address - Include City & State Which Animal Are You Applying For?
Home Phone Work Phone
eMail Address
Employer Name Spouse Employer
Number of Children Age of Children
Is everyone in the household in agreement about adopting a dog?
Name and Phone Number of Your Homeowners Insurance Agent/Company
Please Describe Current Living Situation
Contact Information for Landlord" (if applicable)
What Type of Environment is Your Home Located?
Besides Immediate Family Are Other Residing In Your Home?
If others are living in your home besides immediate family please give details, including names and ages
Does Your Home Have A Yard? Is Fence Secured With Padlock?
If Yes is it Fenced?
Is Fence Secured Underground?
Type of Fence and Height

Adoption Information

Is Someone Home During The Day?
If no, where will dog stay?
Where Will Your Dog Be Kept Most of The Time?
If Kept Outside, Will You Have a Dog Run/House? - Please Give Details Below
Where Will Your Dog Sleep At Night? Will You Take Dog To Obedience Classes?
How Do You Feel About Crating Your Dog? Have You Ever Owned A Dog?
Where Is that Dog Now?
Prefer Male or Female? Age Range Preferred?
Why Do You Want A Dog?
Used For Guard Dog? Years You Plan On keeping Dog?
What Activities Do You Plan On With Your Dog?
What Type of Traits Are You Looking For In A Dog

Other Pet Information

Do You Own Other Pets? Other Pet Type?
(Please List Age, Sex and Breed)


Are All Pets Spayed/Neutered? Are All Pets Vaccinated?
Are All Pets on Heartworm Prevention? What Type?
Willing To Pay For Heartworm Test?
Veterinarian Name and Phone Number

If You Have Current Pets and Veterinarian Office Please List Pets Name and Owners Name (On Record at Vet's Office)
If Applicable, when Was Your Current Pets Last Visit?
List All Pets You Have Had In The Past 10 Years and What Happened To Them.
List any Humane Societies, Organizations, Breed or
Training Clubs You Are Associated With
We will attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realized that often times the complete history of a dog may not be known and you may encounter some behavioral problems?
If Applicable, Are You Willing To Help Work With Us To Correct These Issues?
Please Provide the Name, Address and Phone Numbers of Three References
 
Additional Comments or Concerns?

CERTIFICATION

By clicking the submit button below I certify that the information provided on this form is true & correct. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able to meet these requirements.
Home checks are made on a random basis following or prior to adoption. If upon inspection we find that information contained in this application to be false, we retain the right to turn down or remove the animal from your premises without a refund of moneys paid.

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