* denotes required field

Applicant\'s Name*:

Applicant\'s E-Mail Address*:

Home Telephone Number*:

Work/Cell Phone Number:

Address*:

City*:

Postal Code*:

Personal Information

Have you submitted an application to Ugly Mutts previously?

 Yes No

Please give us an idea of your household situation such as number of adults and their occupations, children in the home and their ages, others in the home*:

Does your entire household agree to this adoption*?
 Yes No

Is anyone in your household allergic to animals*?
 Yes No

If so, what kind:

Do you currently own other pets*?
 Yes No

If yes, please give age and breed of pet:

Are all current pets up to date with vaccinations?
 Yes No

Are all currently owned pets spayed or neutered?
 Yes No

If not, please give reason why:

Current Veterinarian\'s name and phone number:

What is your past experience with dogs or cats*?

Do you currently rent or own your home*?
 Rent Apartment Rent House Own Condo Own House

Landlord\'s name and phone number if applicable:

Is your home located on*:
 City lot Country lot Acreage

If you live in a house is there a fully fenced yard?
 Yes No

Please list a reference name, email address and/or phone number that knows you as a pet owner or who can vouch for your overall responsibility*:

About Your Desired Pet:

If you are applying for a specific pet posted on our site, please give their name and ID#:

If already adopted, would you like us to keep your application on file in case a similar pet comes available for adoption?
 Yes No

If you have spoken with an Ugly Mutts Associate please give their name:

What is your reason for wanting a pet*?

If you did not see a specific pet on our site that you are interested in, please tell us the specifics of what type of pet you would like to adopt:

If the pet is not altered do you agree to have it done when the pet reaches maturity at your expense? (at approximately 6 mths of age)
 Yes No

If adopting a dog, what are your plans for exercising the pet?

Will the pet live mostly:
 Mostly indoor Mostly outdoor Only Indoor Equal time spent indoor and outdoor

How many hours of the day will the pet be left at home on its own during the day*?

Are you willing to give a home to a pet that has any of the following issues:
An Elderly PetTraining IssuesMedical IssuesAny of the AboveNone of the Above

What type of issues would you be willing to work on with a pet such as house training, chewing, barking, crate training, etc.*:

What type of pet issues would be unacceptable to you and cause you to return a pet*?

How long would you give your new pet to adjust to its new home*?

In your opinion, what is the best quality in a pet*?

In your opinion, what is the worst fault in a pet*?

Would an unscheduled visit before or after adoption from an Ugly Mutts Associate be acceptable to you*?

\"Upon submitting this application, I agree that the addition of a family pet is an important decision. I have thought through possible changes in my life, and feel that I would still be willing and able to care for a pet should they occur.\"

You have read and agree to the above statement*:
 Yes No

Where did you hear about Ugly Mutts Dog Rescue?

This application is used for screening purposes only, and does not denote a commitment to adopt.