Dog Adoption | Murillo Mutts

Owner Information

Are you interested in a particular dog we have available?*

Name*

First & Last Name

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Enter Email Confirm Email

Contact Telephone Number*

Mobile Telephone

Occupation*

Best Time to Call:*

Residence Information

Do you own or rent your home?*

Own
Rent

If you rent, do you have your landlord’s permission to keep a dog?*

Yes
No
Not Applicable

Name of landlord

First & Last Name

Phone

Do you live in a:*

House
Apartment
Trailer
Other

If other, Please describe:

How long have you lived at this address?*

Household Environment

Name all the adults in the house*

Ages of adults:*

(In Months or Years)

How many children are in the home?*

Please enter a number from 0 to 100.

If there are children, list ages:

(In Months or Years)

Are any members of your household allergic to animals?*

How many hours per day will the dog be left alone?*

Please enter a number from 0 to 24.

Where will the dog be left when alone?*

Inside
Outside
Crated

How is the dog contained on your property?*

Free Roaming
Tie Out
Leash Walking
Chainlink Fence
Wood Fence
Electric Fence

If you have a fence, how high is it?

Do you have a kennel run?*

Yes
No

Describe your kennel run and or fence; height, type, and size

If you do not have a fenced yard, how will you handle exercise and toilet needs?*

Do you have a suitable dog crate?*

Yes
No

Activities

How would you describe your lifestyle?*

Active
Passive

What is your preferred level of exercise with the dog?*

Describe a regular week (how many walks, duration, etc)?*

Will there be any off-leash activities?*

Explain*

Describe other visitors to your home, human or animal, with which a new dog will have to interact?*

When you go on vacation, who will care for the dog? (Friend, kennel, dog sitter, etc.)?*

Other Animals

Do you own other dogs?*

Yes
No

If yes, list breed, colour, size, age (In Months or Years) and gender of each:*

Are they spayed and/or neutered?*

Yes
No

if not, why not?*

Are their vaccinations up to date?*

Yes
No

if not, why not?*

Do you own cats?*

Yes
No

If yes, list breed, colour, size, age and gender of each:*

Are they spayed and/or neutered?*

Yes
No

if not, why not?*

Are their vaccinations up to date?*

Yes
No

if not, why not?*

Do you own other animals?*

Yes
No

If yes, describe other animals:*

How many and types of dogs have you owned in the past five years that you have not described above*

If you do not still own the dog(s), what happened to it (them). Please be specific:*

Have you participated in obedience training with any of your dogs in the past?*

Yes
No

Would you be willing to participate in obedience training and socialization with your dog?*

Yes
No

Is there any behaviours you will not tolerate in a dog?*

What would you do with your dog if any of the above behaviours present themselves?*

Is there a reason you would return the dogs to the rescue?*

Planning

When can you take the dog*

What activities do you have planned for this dog*

Pet
Guard
Hunting
Obedience
Agility
Trials

Do you plan to keep this dog primarily:*

Indoors
Outdoors

Where will the dog sleep?*

What will the dog eat?*

Do you have a regular veterinarian clinic?*

Yes
No

Name*

Veterinary Clinic

Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Do you consent to Murillo Mutts Respite Refuge contacting your vet as a reference?*

Yes
No

Your Preferences

Do you prefer to adopt*

Male
Female
Either

What age of dog would you prefer?*

Puppy
Young adult
Senior
Doesn't matter

Would you consider a different age or sex*

yes
no

Do you understand the breed specific needs of the dog you are asking to adopt*

yes
no

References

Name*

Reference #1: (should not be a relative)

First & Last Name

Relation*

Phone*

Name*

Reference #2:

First & Last Name

Relation*

Phone*

How did you hear about Murillo Mutts Respite Refuge?*

Facebook
Friends
Other

Optional

Thank you for your interest in supporting Rescue Dogs!

Any comments or questions?

Disclaimer and Terms of Acceptance

Disclaimer: If for any reason you are unable to keep the dog in the future, the dog must be returned to Murillo Mutts Respite Refuge for re-adoption as opposed to being turned in to a pound, sold or placed through a free-to-good home ad. Unless for extreme health issues no dog adopted from us may be euthanized or re-homed without our written consent. Murillo Mutts Respite Refuge reserves the right to repossess any adopted dog in the event that, the rescue has reasons to believe the dog is being mistreated, or if information supplied on this form is discovered untruthful. In submitting, below you are agreeing to the terms as outlined above. If the terms are not met you will be liable and legal action may be taken. Legal Obligations: Murillo Mutts Respite Refuge can not be held responsible for any damages that occur in adoptive homes, and is not liable for direct, indirect, incidental, special, or consequential damages arising out of, or relating to dogs adopted through Murillo Mutts Respite Refuge, whether framed as a breach of warranty, upon any legal theory, in tort, contract, failure of essential purpose, or otherwise. Murillo Mutts Respite Refuge makes no warranty, express or implied regarding any of the dogs in our rescue. Adoptive families are obligated to report any concerns to the rescue, and any dog adopted through Murillo Mutts Respite Refuge will be accepted back into our rescue in the event they are not working out in their adoptive home. In the event of any emergency, where a dog needs to be removed immediately, please contact Robin at (807) 939-1855. All dogs adopted from Murillo Mutts Respite Refuge within the city of Thunder Bay must be licensed with the City of Thunder Bay Animal Services. Privacy Policy: Throughout your dealings with Murillo Mutts Respite Refuge, information provided on your adoption form will be kept on record, for our adoption files. This information will not be used in any solicitation and will not be provided to any organization exterior to our rescue. If you have any concerns about personal information being kept on file, please contact Robin at (807) 939-1855. The terms and agreements outlined in this document are legally binding. By submitting this form, you agree that you are aware of the terms of agreement outlined here, and by your submission, you acknowledge that you have read and agree to the terms as outlined by Murillo Mutts Respite Refuge. Submission of this form acts as your electronic signature also provides verification that you accept these terms and conditions. If the information above is found untruthful, you will be held liable for fines and costs.

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Murillo Mutts - Dog Adoption Application

Owner Information

Residence Information

Household Environment

Activities

Other Animals

Planning

Your Preferences

References

Optional

Disclaimer and Terms of Acceptance