ANIMAL PROTECTION LEAGUE OF MERCER COUNTY PO Box 663        Celina, OH 45822 Phone: (419) 586-2887 www.aplmercer.com Email: info@aplmercer.com Name of Pet you want to adopt: Name: Spouse/Co-Applicant: Address: City/State/Zip: Telephone: Email: Cell Phone: Is this dog going to be an inside or outside dog? Are you looking for a long haired or short haired dog? What size of dog are you looking for? Are you looking for an active or quiet dog? Does anyone in your home have an allergy to dogs? Have you ever housetrained a dog before? If your dog behaved badly, how would you correct his behavior? Do you own your own home? If you are a renter, how long have you lived at this address? Are you allowed to have pets in your rental? If you rent, landlords name and number: Do you have a fenced in yard? If yes, please describe the area. How will you exercise your pet? How many hours per day will your pet be left alone for work? Where will you keep your pet when you are not home? How many adults live in the home? Ages? How many children live in the home and what are their ages? List any pets you have currently, including sex, ages and whether they are spayed or neutered. List any previous pets you have had and why you no longer have them. What would cause you to no longer be able to keep this pet? What would you do with the dog if you couldn’t keep her/him? What will you do with your pet when you are vacation? Have you ever had a dog that was hit on the road before? Your Current Veterinarian: Address: Telephone: We require two references in order to process your application. You may use your veterinarian as one reference. Reference #1: Telephone: Reference #2: Telephone: Are you willing to allow a pre-adoption visit? The Animal Protection League of Mercer County has set forth rules that we deem appropriate for the animals needs. We do not wish to offend anyone nor are we trying to eliminate your application from being considered. We are trying to match the right dog with the right family so the animal has a forever home. As such, please carefully consider the following behaviors that you can not or will not tolerate in the pet. This will allow us to make the best match possible for both you and the animal. Check which behaviors would make you not want to adopt this dog (check all that apply) _______ Pet chews belongings _______ Pet barks too much _______ Pet has housetraining problems _______ Pet jumps on people _______ Pet is too hyper _______ Pet sheds too much _______ Pet requires grooming _______ Pet requires too much vet care _______ Pet scratches furniture _______ Pet digs holes _______ Pet pulls on leash _______Pet does not interact well with other pets or family members Other behaviors (describe) Have you ever applied to adopt a dog from other rescues? Name and number of rescue organization: If so, what was the outcome? This part is to be initialed and signed when you come to complete adoption. Please read the following before submitting application: I understand that by adopting this pet I agree to return it to the APLMC at my own expense if I am no longer able to keep it for any reason (with the exception of age or serious illness that will prove terminal to the animal).  I agree to this condition: ___ _______    __________ I understand that the APLMC is not responsible or liable for this pet immediately upon receipt by me. I agree to this condition: ___ _______    __________ I understand that if abuse or neglect is found or if my check bounces, I am required to return the pet at my own expense upon written request. I agree to this condition: ____ ______    __________ I understand that I will maintain this pet as a companion animal. This animal will NOT be used for fighting, baiting, or aggressive (attack or guard dog) training. I agree to this condition: ___ ______    __________ I understand that if I violate some or all of this agreement I will be called to court proceedings in Mercer County, Ohio and I will be required to return the animal to the APLMC and pay court assessed damages for violating this contract. I agree to this condition: ____ ______    ________ I understand that this is a legally binding contract upon my signature: ______ ________ A non-refundable adoption fee of $_________ is required for this pet.   Date Pet Adopted: Applicant Signature: Co-Applicant Signature: APLMC Representative: