........................................................................................ Lisa Dean

.......................................................................................................................Salem, Ohio

Directions: Copy/paste this form into an email addressed to mastiffmom845@yahoo.com Fill in the application within your email & send. We suggest you print your completed application before sending.

Moistmugs Mastiff Rescue and Placement Family Profile

NAME: __________________________________________ADDRESS: ________________________________________

CITY: ____________________________________________ STATE: _______________ ZIP CODE: ________________

TELEPHONE: (home) _______________________________ (work) ___________________________________________

OCCUPATION: _____________________________________ E-mail: __________________________________________

NAME AND RELATION OF ADULTS LIVING IN HOUSE:
NAMES AND AGES OF CHILDREN LIVING OR VISITING REGULARLY IN HOME:

OTHER PETS OWNED (breed, age, sex of each):

ARE YOUR PETS NEUTERED OR SPAYED? ___yes ___no (if not, why not?)

DO YOU (choose appropriate) ___own ___ rent ___house ___apartment ___condo

HOW LONG HAVE YOU LIVED AT PRESENT ADDRESS?

DO YOU HAVE A FENCED YARD? ___yes ___no describe fence:

APPROXIMATELY WHAT SIZE IS YOUR YARD?

WHERE WILL YOU KEEP THE MASTIFF DURING THE DAY WHEN YOU ARE AT HOME? WHILE AWAY?
WHERE WILL THE MASTIFF SLEEP AT NIGHT?

HOW WILL THE MASTIFF BE CARED FOR OVERNIGHTS OR VACATIONS?

HOW MUCH TIME WILL YOU SPEND WITH THE MASTIFF DAILY?

WHO WILL BE THE PRIMARY CAREGIVER?
ARE ALL FAMILY MEMBERS GONE DURING THE DAY? (work/school) _____ yes____ no

HAVE YOU EVER OWNED A DOG? _____ yes _____ no if yes what happened to it?

HAVE YOU EVER OWNED A MASTIFF? _____ yes ____ no if yes 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 FROM RESCUE?

ARE YOU FINANCIALLY PREPARED TO OWN A MASTIFF?

HOW MUCH DO YOU THINK IT COSTS PER MONTH TO FEED AND CARE FOR A MASTIFF?

LIST YOUR VETERINARIAN (name, address, phone)

LIST A PERSONAL REFERENCE (one that is familiar with you and your family)
(name, address, phone)


PLEASE NOTE THAT THERE IS AN ADOPTION FEE OF $150.00 to $300.00
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, in my home, with a volunteer, if requested, to determine the suitability of my facilities to care for a Mastiff. I further agree that this home visit will be done prior to my being approved to adopt a Mastiff from this rescue.

PRINT NAME: ______________________________________

APPLICANT' S SIGNATURE: ____________________________________________ DATE: _________________

VOLUNTEER' S SIGNATURE: ___________________________________________ DATE: _________________