Before filling out this application, please read our Adoption Policies. PLEASE NOTE: Only adopters residing in the Rochester, NY local area will be considered!!! Name (required) Email (required) Address (required) Birth Date (required) Phone Number (required) Are you or your spouse a former or current member of the US Military (required) Yes No Vet Name Vet Phone Number Vet Address How many years with this Vet? Reference (Non-relative) Phone Number Relationship Friend Colleague Neighbor Other Time Known Breed of Dog Interested In Beagle Boxer Bulldog Cocker Spaniel Chihuahua Chow Chow Dachshund German Shepard Golden Retriever Husky Labrador Retriever Pitt bull Poodle Pug Rottweiler Shih Tzu Terrier Other Other Breed (not listed) Interested in a Specific Dog Preferred Age 1 year 1 year 6 months 2 years 2 years 6 months 3 years 3 years 6 months 4 years 4 years 6 months 5 years 5 years 6 months 6 years 6 years 6 months 7 years 7 years 6 months 8 years 8 years 6 months 9 years 9 years 6 months Preferred Size Very Small Under 10lbs Small 10-30lbs Medium 30-45lbs Large 45--75lbs Extra Large 75-150lbs Preferred Gender M F Do you have a fenced in yard? Yes No Where will the dog be kept when alone? How many hours per day will the dog be alone? What kind of food do you plan to feed your dog? (Flint River Ranch is a great choice! Ask us about it!) If not housebroken, how do you plan to train your dog? Tell us why you want to adopt a dog. Do you currently have pets? (Required) Yes No (Please skip to the rent or own question.) Please List all names, species, breeds, gender & ages. (Required) Are your other pets up-to-date on heartworm prevention and vaccinations? (Required) Yes No Spayed or Neutered? (Required) Yes No If no for either, explain why Have you previously owned pets not listed here? (If so, please explain what became of them) Do you rent or own? Rent Own If renting, landlord's name and phone number Please list names and ages of all other household members Additional information or comments you would like to share with us How did you hear about us? Referral Internet Search News Channel 10 Radio Previous Adopter Event I hereby certify that all statements made herein make full disclosure and are true. There has been no event or information not disclosed in writing which could reasonably be expected to have an adverse effect on the health, comfort, safety or well-being of a dog. I am aware that my application must be approved before any adoption can take place. Such approval will include, at a minimum: Contacting my personal and veterinary references, contacting my landlord (if applicable), and a home visit by a Nuts for Mutts Rescue volunteer. By submitting this application I am agreeing to all adoption policies and procedures set forth by Nuts for Mutts Rescue, Inc. and agree to abide by whatever decision Nuts for Mutts Rescue, Inc. determines appropriate. Yes No Leave a Comment Cancel replyYou must be logged in to post a comment.