Use this easy form to complete your application or if you prefer, you can download this form here in Adobe Acrobat, print it and after completion mail or FAX to:

Mid-Florida Retriever Rescue, Inc.
15195 Angus Road
Polk City, FL 33868
FAX:  863-984-5370

Mid-Florida Retriever Rescue DOES NOT request a Processing or Application fee.

Before completing this application, please be aware of the following:

1. Applicants must read and agree to our Adoption Policies.

2. All fields below must be filled in.

3. Mid-Florida Retriever Rescue is not a Pet Store.  Our volunteers are only interested in working with serious applicants, ready to travel and meet potential Labs NOW.

4. Adoption fee is $250.00 (Non-Refundable for Puppies 6 months or less)

Name
Co-Applicant Name
Address
City & State
ZIP or Postal Code
Home Phone
Work/Cell Phone
E-mail Address
Applicants work hours

Do you own or rent?    Please Select Own Rent

Type of Home:    Please select House Apartment Townhouse Condo

 
 
How long have you lived at this address?

Describe your ideal dog (i.e. temperament, activity level, etc.)
 

Type of Lab Requested:
Sex:                                                              Please Select No Preference Female Male
Color:   Please Select No Preference Black Chocolate Yellow
Age range: Please Select No Preference Puppy Young Adult Mature
How long are you willing to wait for the best match? Please Select As long as it takes. A few weeks. A few months. A year.

Home Environment:

Other household residents (besides applicant)?
Name                                      Age            Relationship
 

Primary person responsible for the Lab:
 

Estimated cost to care for a dog for one year:
 

Is anyone in your house allergic to animals?
  Please Select Yes No

If yes, please explain below:
 

Is your yard completely fenced?   Please Select Yes No

If yes, type of fence:    Height of fence:  

If no, how will you contain the dog to your property?   

How many hours a day will the dog be alone?  

Where will the dog be when no one is home?  

Where will the dog be at night?  

How many hours will the dog be outside alone?  

Do you plan to allow the dog off leash in an unfenced area?   Please Select Yes No

If yes, explain:

Training:

Are you willing to crate train the dog, if necessary?   Please Select Yes No

Where will you take your dog for training?  

Phone number of trainer:  

How will you exercise your dog?  

What will you do with your dog when you travel?  

Pet Experience:

Have you owned a dog in your adult life?                                                               Please Select Yes No

If yes, what happened to him/her?

Have you ever had a pet die at an early age?  Please Select Yes No

If yes, please explain:

Do you have pets now?                                                               Please Select Yes No

If yes, list current pets here:  Please list Name, Type/Breed, Age, Sex and if they are neutered or spayed. 

How do your current pets behave with other dogs

What dog food do you plan to feed (brand, dry/moist)?                                                              

What behavior would cause you to give up your dog? 

References:

Is this the vet you:                                                              Please Select Currently use Plan to use Both

How did you hear about Mid-Florida Retriever Rescue, Inc.?                                                               Please Select Internet Family/Friend Newspaper Ad Vets office Shelter Show/Event Other

Have you read the Mid-Florida Retriever Rescue adoption policies?    Please Select Yes No

Do you agree to abide by the policies?                                                               Please Select Yes No

Additional comments?

I certify that the information I provided in this application is true and correct.  I authorize Mid-Florida Retriever Rescue, Inc. to contact any and all references to verify the information that I have provided.  I am at least 18 years of age.  This dog will reside in my home as a pet.  I will provide it with adequate food, water, shelter, training, affection, and medical care.  I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it.  I will not relinquish ownership, abandon, or dispose of such a dog in any way.  If I cannot keep it. I will relinquish the dog over to Mid-Florida Retriever Rescue, Inc. I am in full agreement with these terms of adoption.  I acknowledge that any misrepresentation may result in removal of the adopted Lab from me by Mid-Florida Retriever Rescue, Inc.  I have read and agree to the Adoption Policy of  Mid Florida Retriever Rescue, Inc.

Signed and submitted this  day of  ,20.

Enter this code in the space below:   53pa37   This is your digital signature.

Applicant                                                                       Co-applicant