MIDLAND COUNTY PIT STOP
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Midland County Pit Stop Pet Adoption Application
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Indicates required field
Date:
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Pets Name:
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Applicant Information
Name:
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Physical Address
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City
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State
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Zipcode
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Most Recent Previous Address
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City
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Day Phone
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Cell Phone
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State
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Zip Code
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Email
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**Signature will be required upon approval of Application
PERSONAL OR PROPERTY DAMAGE AND/OR INJURY
I acknowledge and agree that if the animal bites and other injuries to humans and other animal so occur, I will not hold Midland County Pit Stop 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 in Midland, MI will not be responsible for any damage the adopted dog 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, and no attempt 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.
**If for any reason you are unable to care for or keep the above animal, he/she must be returned to
Midland County Pit Stop of Midland MI
Signature
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Date
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APPROVED BY (Midland County Pit Stop Foster Liason)
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Current/Previous Pet Info
Have you ever owned a dog or cat?
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Yes
No
Do you currently have pets?
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Yes
No
Type/Breed/Name/Age/Veterinarian Info/Spay,Neuter/UTD
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Date
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Home/Family Information
Spouse/Roommate's Name
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Number of adults living in your household
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Number of children in your household
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Do you rent or own?
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Rent
Own
Which best describes the area you live?
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City
Suburb
Rural
How long have you lived at this address?
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Do you have a yard?
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Yes
No
How high is your fence?
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Primary Pet Caretaker is
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Employed full time
Employed part time
Retired
Stay at home or work from home
College Student
Check all that apply
Other-please indicate
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What Hours Primary Caretaker is home
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In the event the main caretaker is unable to care for the pet, what are your plans for the pet?
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Will this pet be kept
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Indoor
Outdoor
Both
Do ant of your household members suffer from pet dander related allergies?
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Yes
No
Do you need your pet to be
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Dog Friendly
Cat Friendly
Child Friendly
Are there specific breeds you prefer or have experience with? *
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Care Plan
If you do not have other pets, how will you socialize your new pet?
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How many hours a day will your pet be alone?
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Where will your new pet stay when no one is home?
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Where will your new pet stay when you are home?
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Where will your new pet stay when you are out of town or on vacation?
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Home visits are required prior to adoption approval and placement by an adoption liaison. PLEASE INITIAL
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Have you ever surrendered a pet to Animal Control, a Humane Society, Rescue or individual?
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Yes
No
If Yes, please explain
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Veterinary Care
Where will you vet your new pet?
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Are your current pets on heartworm preventative?
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Yes
No
Tell us about your experience with pets
Comment
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Once the pet you are applying to adopt is deemed adoptable by the Adoption Liaison, you may begin the adoption process PLEASE INITIAL
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FOR OFFICE USE ONLY
Adoption Liaison approved for adoption
DATE
_______________________________________
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Meet & Greet
Home Visit (1) Location ____________________
Date___________
Adoption Liaison Comments ____________________________________________
___________________________________________________________________
___________________________________________________________________
Home Visit (2) Location ____________________
Date ___________
Adoption Liaison Comments _____________________________________________
____________________________________________________________________
____________________________________________________________________
Submit
Home
About
Adopt Me!
K-9
Feline
Forms
Donations
The Plan
Contact
CommUnity
Event Calendar
I Want to Adopt
I Want to Foster
Surrender My Pet
Find a Foster for My Pet
I Want to Help!