MHCR Adoption Application Adoption Application Today's Date* Date Format: MM slash DD slash YYYY Primary Applicant Name* First Last Spouse/Legal PartnerCo-Applicants include married couples or legal domestic partnerships. First Last Relationship to Primary Applicant I understand that if I am not married or in a civil union at the time of adoption, only one person can be the owner of any dog I adopt and that person will be me, the primary applicant.* Yes Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Type*Choose oneCellularLandlineEmail* Enter Email Confirm Email Join our Mailing list for Newsletters and exciting happenings? We utilize Mailchimp as our marketing automation platform. By opting in, you acknowledge your name and contact info will be transferred to Mailchimp for our newsletters ONLY.Have you applied recently with another rescue?*Choose oneYesNoIf yes, what is the name of that rescue?*This will help us streamline the approval process.Date of Birth of Primary Applicant* Date Format: MM slash DD slash YYYY Do you own or rent your home?*Choose oneOwnRentA family member owns my homePlease upload proof of ownership or permission from landlord to adopt a dog.*Proof of ownership can be a property tax statement, mortgage statement, Homeowner's insurance policy, etc. Landlord permission should include breed/age/size restrictions.Please tell us about the human members of your household (enter N/A if none):*Include anyone that lives with you full or part-time.NameAgeGenderRelationship to you Is anyone in your home allergic to dogs?*Choose oneYesNoMildly, but we've managed itHas anyone in your home been convicted of or charged with neglect or abuse to animals or children?*Choose oneYesNoPlease tell us about the animals on your property (enter N/A if none):*Please include dogs, cats, ferrets, rabbits, birds, chickens, horses, etc. SpeciesBreedSexAgeSpayed/Neutered If you have non-canine or non-feline animals, please answer the following:* My pets are in a secure outdoor enclosure My pets have free roam of my home/yard My pets have a secure indoor enclosure My pets/livestock have a fenced in area on my property My newly adopted dog will not have access to my other non-cat/dog animals My newly adopted dog will have access to my non-cat/dog animals This question is not applicable to me. Please tell us about your fencing/yard/outdoor area.* I do not have a yard My yard is not fenced My yard is partially fenced My yard is fully fenced My fence is under 3' tall My fence is 3-4' tall My fence is 5' -6' tall My fence is taller than 6' My fence is a privacy fence My fence is split rail My fence has chicken wire My fence is livestock fencing I live on acreage I live in an urban area and my dog will be leash walked in populated areas How often, on average, will your adopted dog be home alone?* less than 2 hours 2-6 hours 6-9 hours over 9 hours Where will your new dog be kept when you're not home?* In a crate inside my home In a crate in my garage In an indoor/outdoor run connected to my home or garage Free roam in my home without access to the outdoors Free roam in my home with access to outdoors Confined to a room inside my home At doggie daycare Outside Where will your new dog sleep?* In a crate inside my home In a crate in my garage In an indoor/outdoor run connected to my home or garage Wherever they want inside my home Confined to a room inside my home On a dog bed inside my home On my couch or bed Outside/Dog House Please tell us why your family would like to adopt a dog.*Please tell us which dog you're interested in:*Will you consider another dog if the dog you've applied for isn't available?*Yes, I'm openNo, thank youPlease tell us what type of dog you'd consider:*Include specifically what parameters you have for your dog search. Examples are age, breed, sex, size, etc.Please tell us about your experience with dogs.*Include information such as breeds you're experienced with, your overall exposure to dogs, and what you feel their role in the home should be.What will you absolutely NOT tolerate from your new dog?*This section is designed to help us understand what would cause you to re-home a dog. Please answer honestly. House Training (peeing or pooping in the house) Crate Training (barking or whining in the crate at night or when alone) Basic Obedience Marking in the house Barking Timid or fearful Jumping on people Aggression to other dogs Aggression towards cats or other pets Fence jumping Pulling on a leash Barking/lunging/or otherwise "aggressive" behavior towards humans Food aggression Intolerant of children Getting on furniture Separation Anxiety Ongoing medical needs I will work with any behavior Under what medical circumstance would you seek to euthanize or return your dog to MHCR?*This section is designed to help us understand your ability and willingness to address health/medical issues as they arise. Please answer honestly. An accident or injury that is treatable/curable, such as a broken leg, requiring urgent medical attention costing $3000 or more An accident or injury that is treatable/curable, such as a broken leg, requiring urgent medical attention with an expected bill of less than $3000 Diagnosis of a lifelong medical condition requiring daily medication Incontinence - leaking urine Blindness/deafness An accident or injury that would require in home rehab and recovery for a period longer than 2 weeks None of these. In your honest opinion, what are acceptable reasons to surrender your dog back to MHCR?*Please answer this question honestly. If I got a divorce If I have to move out of state If I have to move out of the country If I get a new job If it no longer suits me to have a dog If I have a baby If I get a new dog and my old dog doesn't like it If I decide I'd like a different dog If it starts chewing my furniture or peeing on the floor None of these. I would keep my dog. Have you ever given away/rehomed/surrendered a pet?* Yes No If yes, please explain:*Include when, type of pet, conditions of surrender or rehome, etc.Have you had a dog or puppy with parvo virus within the last 5 years at your property?*Choose oneYesNoDo you understand that a dogs behavior in their foster home is NOT an indicator of what the dogs behavior will be in your home?* Yes Do you understand when you adopt a dog from MHCR, you are not permitted to re-home/surrender/give away the dog you adopt without prior written consent of MHCR?* Yes Do you understand MHCR often receives multiple applications for one dog and we do our best to choose the best possible fit?* Yes Do you understand MHCR has a 7 day trial adoption period wherein an adopter has 7 days to terminate an adoption and shall be entitled to a 50% refund of the adoption fee?* Yes Do you understand that it may take longer than 7 days for a new dog to acclimate to a new home?* Yes Thank you for taking your time to complete this application. By typing and signing your name below, you attest to the truthfulness of your answers. Falsification of any of the above information may result in denial of your application for adoption.* First Last Signature*
Mile High Canine Rescue