First & Last Name: Address: City: State: Zip: If at current residence for less than a year: Previous Address: Previous State: Previous Zip: Phone: Work: Fax #: Email: Names and relation of other adults in the household: Names and ages of children living or visiting on a regular basis in the household: Other pets owned (breed, age and sex of each): Are your animals neutered and/or spayed? Yes No If not, why not? Do you (choose those that apply) own rent house apartment condo How long have you lived at the present address? Do you have a fenced yard? Yes No Describe the type of fencing, including height: Approximately how large is your yard? Where will you keep the Mastiff during the day when you are home? While you are away during the day? Where will the Mastiff sleep at night? How will the Mastiff be cared for on overnight absences or while on vacation? How much time will you be able to spend with the Mastiff daily? Who will be the main care giver? Are all family members gone during the day (work/school)? Yes No Approximate hours? Have you ever owned a dog? Yes No When? What happened to it? Have you ever owned a Mastiff? Yes No If so, what happened to it? How many dogs can you legally have where you live? Is there a leash law? Yes No What made you choose the Mastiff breed? What made you decide to adopt a Mastiff from a Rescue Organization? Are you prepared for the financial responsibility of owning a Mastiff? Yes No What do you think it costs per month to feed and care for your Mastiff? Would you be willing to pay for transportation costs or to travel a reasonable distance to help bring a Mastiff from another state? Yes No Are you interested in giving foster care to a Mastiff while awaiting the Mastiff of your choice? Yes No (Foster families may be given priority in adopting the Mastiff in their care). Name, address and phone of you Veterinarian: Name, address and phone of another reference (preferably one that is familiar with your care of animals): Do you prefer a male female Age preference Any other information you feel is important in helping us determine the best match in a Mastiff for you and your family? If you learned about the Mastiff from books, we strongly suggest that you let us know so we can put you in contact with someone in your area or tell you about upcoming shows so you can see the Mastiff up close and personal. Please note that there will be an adoption fee set by the rescue organization that you will be adopting from. I certify that the above information is true and I understand that prior to the placement of a Mastiff in my home the above information will be verified. I also agree to a personal interview with an MCOA volunteer, if requested, to determine the suitability of my facilities to care for a Mastiff. I understand that a home visit will be done prior to my being able to adopt a Mastiff thru MCOA Rescue. Print Name:____________________________ Signature:______________________ Date___________ Print Name:____________________________ Signature:______________________ Date___________ Coordinator comments/date: _____________________________________________ Code #: ___________________________________
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