I Want to Adopt

Midland County Pit Stop Pet Adoption Application

1.) This application must be filled out in its entirety to be considered for potential adoption.
2.) Animals will not be adopted to minors under 18 years old.
3.) False or incomplete applications will be considered null and void.
4.) Our Application Dept. will be contacting your current/recent vet(s) and asking for vetting history. We require all current and recent pets be spayed/neutered, current and recent pets must be vaccinated and have been consistent on them. We require annual Heartworm Testing and that the current and recent pets by on HW Preventative consistently.
5.) A background check will be performed on all residents in the home 18 and older.
6.) Some pets may require a fenced in yard and that will be discussed early in the process of an application.
7.) It is important that a pet and the new family be a match in temperament, activity level and family dynamics and we strive to make sure that occurs.
8.) Filling out this application does not guarantee an adoption is approved. We reserve the right to deny any application.

* Indicates required field

Today's Date: *

Pet's Name You're Applying For: *

FOR OFFICE USE ONLY
Payment Date
Payment Amount
Form of Payment
Additional fee for debit/credit card payment

Adoption Applicant Information

Full Legal Name: First, Middle and Last *

Date of Birth *

Physical Address ( PO Boxes are not accepted) *

City *

State *

Zip Code *

Previous Address *

City *

State *

Zip Code *

Day Phone *

Cell Phone *

Email *

References

Please provide three references who are not considered family or living with you.

First and Last Name *

Phone Number *

Current/Previous Pet Info

Have you ever owned a dog or cat? *

Yes No

Do you currently have pets? *

Yes No

Please list all pets in the last 10 years. Indicate pet name, age, breed/mix, Veterinarian Contact info., S/N, UTD on vaccinations, Annual HW Test and Monthly HW Preventatvie HW (i.e...Macie - deceased (2019) 12.5 yo, Toy Poodle, River Rock, kept UTD on vaccinations, spayed, HW tested annually and on preventative) *

Home/Family Information

Number of adults living in your household *

Number of children in your household *

Spouse/Roommate's Name (First, Middle and Last) and Date of Birth *

Please list anyone else, 18 or older, who lives in your home, first, middle and last name and date of birth *

I give Midland County Pit Stop permission to do background checks on all adults, 18 and older, in the home. ******PLEASE INITIAL****** *

Do you rent or own? *

Rent Own

If you rent, please indicate your landlord's full name or Property Management's Name. We will make contact to verify pet policies *

Landlord or Property Management's Phone Number *

Which best describes the area you live? *

City Suburb Rural

How long have you lived at this address? *

Do you have a yard? *

Yes No

Is it fenced? If so, how high is the fence? Please note some dogs may require a fenced yard but not all do. Interviewer can make sure you are aware of any requirement *

Primary Pet Caretaker is *

Other - please specify *

What hours primary caretaker is home *

In the event the main caretaker is unable to care for the pet, what are your plans for the pet? *

Do any of your household members suffer from pet dander related allergies? *

Yes No

Do you need your pet to be *

Dog Friendly Cat Friendly Child Friendly

Are there specific breeds you prefer or have experience with? *

Care Plan

Will this pet be kept *

Indoor Outdoor Both

Where will your new pet stay when you are home? *

Where will your new pet stay when no one is home? *

How many hours a day will your pet be alone? *

Where will your new pet stay when you are out of town or on vacation? *

If you do not have other pets, how will you socialize your new pet? *

Virtual home visits are required prior to adoption approval and placement by an adoption liaison. **PLEASE INITIAL** *

Veterinary Care

Vet Checks are part of our application process. All current and recent pets in the home must be spayed/neutered, vaccinated annually and consistently, HW tested annually and on monthly HW Preventative.

Where will you vet your new pet? If you are not currently established with a vet, once approved and prior to adoption, applicant make appointment with the prefererred Vet and give them permission to confirm with our Adoption Liaison. *

Are current pets and were recent/past pets up to date (UTD) on vaccinations and vaccinated consistently? (Rabies, required by Michigan State Law and Distemper) *

Yes No

Are current pets and were recent/past pets tested annually for Heartworm? *

Yes No

Are current pets and were recent/past pets on consistent monthly Heartworm Preventative? *

Yes No

If you have vetted at multiple locatations with current or recent pets, please create a timeline *

What is the name of the vet you are currently established with *

Are there medical reasons your pet has not been vaccinated or on preventatives regularly and consistently? (this would need to be confirmed by your vet during the vet check) *

Have you ever surrendered a pet to Animal Control, Humane Society, Shelter, Rescue or individual? *

Yes No

If Yes, please explain *

Once an application to adopt a pet is approved by the Adoption Liaison, a meet & greet will be arranged. *****PLEASE INITIAL***** *

**If for any reason you are unable to care for or keep the adopted animal, contact Midland County Pit Stop. **

PERSONAL OR PROPERTY DAMAGE AND/OR INJURY I acknowledge and agree that if the adopted animal bites or causes other injuries to humans and other animal, I will not hold Midland County Pit Stop of Midland Michigan responsible. I understand that all animals can carry and transmit diseases, including zoonotic diseases that can be transferred from animals to humans. I understand that Midland County Pit Stop will not be responsible for any damage the adopted animal may inflict on another person, another animal or any property, or for the transmission or transfer of any disease or parasite to other animals or people in the household. No attempt(s) will be made by me or anyone on my behalf to hold Midland County Pit Stop responsible. I hereby release Midland County Pit Stop and its agents, representatives/liaisons, and volunteers, and agree to indemnify and hold same harmless from any and all actions, causes of action, suits, debts, dues, accounts, covenants, agreements, judgements, claims and demand of any nature whatsoever arising out of my adoption of a pet from Midland County Pit Stop. I understand that if I am approved as an adoptee to a pet, I must abide by this agreement and that this agreement applies to any and all dogs/cats that I adopt from Midland County Pit Stop. *****PLEASE INITIAL***** *

Adoption fees are non-refundable. ****PLEASE INITIAL**** *

** A Signature will be required upon approval of Application**

Signature *

Date *

APPROVED BY (Midland County Pit Stop Foster Liaison) *

Date *

Submit

Midland County Pit Stop Pet Adoption Application

FOR OFFICE USE ONLY Payment Date Payment Amount Form of Payment **Additional fee for debit/credit card payment**

Adoption Applicant Information

References

Current/Previous Pet Info

Home/Family Information

Care Plan

Veterinary Care

Vet Checks are part of our application process. All current and recent pets in the home must be spayed/neutered, vaccinated annually and consistently, HW tested annually and on monthly HW Preventative.

FOR OFFICE USE ONLY
Payment Date
Payment Amount
Form of Payment
Additional fee for debit/credit card payment