First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Please list any specific type of pet you are looking for (breed, sex, age, size, etc.). You may also list the NAME(s) of an animal(s) that you saw on our website (Please note that this is to indicate your interest, and helps us to better match you with an adoptable pet, and does NOT set a reservation automatically). You may list "IN GENERAL" if you are not applying for any specific type of pet.*

*COVID-19 AND PET ADOPTION* Please note that due to the public health and safety concerns, we are not able to schedule any events in Champaign at the moment. We are currently offering meetings in Murphysboro, IL. Are you able to travel to Murphysboro to meet the pet you are interested in (please note that pets are able to go home with their adopters from meetings if they are a good fit, so you will not need to make multiple trips)?*
Choose one: Yes No

What is your current occupation? If you are married, what is your spouse's occupation?*

How much do you plan on spending on your new pet per month?*
Choose one: $0-$100 $200-$300 $400-$500 $500 and up

Will the animal be kept inside or outside?*
Choose one: Inside Only Outside Only Inside and Outside

How much time (on average) will the animal spend alone during the day?*

Where will the animal be kept when you are home*

Where will the animal be kept when you are away from the house or at work?*

Where will the animal sleep*

Describe how you will train the pet (training techniques you plan to use, skills you would like to teach your pet, etc)*

Have you ever given up a pet? If yes, please explain*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

If you rent, please enter your landlord's name and phone number. If you own your home, enter "OWN"*

If you rent, have you received the approval of your landlord to have an animal? *
Choose one: Yes No Does not apply

Please list the age and sex of all people that will be living with the adopted pet.*

How long have you lived at your current residence?*

Do you have any current pets?*
Choose one: Yes No

How many and what kind of pets do you have? If none, answer "NONE".*

If you do have pets, are they up to date on vaccinations?
Choose one: Yes No

Are your current pets, if any, spayed/neutered?

Have you (or anyone else in your home) had a pet that was ill an any way within the last year? If yes, please explain.*

Do you plan to have your adopted pet fixed (spayed or neutered)? Please explain why or why not*

Veterinarian's Name and Phone Number*

Who in the household will care for the pet*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

If you have a fenced yard, what is the height of the fence

What type of fence*
Choose one: Privacy Chain Link Invisible No Fence

What traits are you looking for in a rescued pet?

Why are you interested in adopting a pet at this time*

How did you hear about us?

Have you applied with any other rescue*
Choose one: Yes No

List at least one reference (who is not a family member), their phone number and relation to you*

Will this adopted pet be your first pet?*
Choose one: Yes No

If this pet will be your first pet, do you feel prepared to care for this pet financially, emotionally and medically? (Please note that we are happy to offer any information that we have about breeds, training, and medical care)*
Choose one: Yes No Does not apply

Midwest Animal Rescue Service (M.A.R.S.) has a dedicated team that works very hard to minimize health issues in the animals in our program. However, the background of some of the animals in adoption programs is ultimately unknown, and health problems may occur in adopted animals. M.A.R.S.utilizes strict quarantine procedure with all of the animals that are available for adoption in our program, and all animals are kept up to date on vaccinations. Even though our organization takes multiple precautions, there are still risks involved. We have an educated staff to answer any questions that you may have about our procedures. Do you understand these risks involved in adoption from this program?*
Choose one: Yes No

Midwest Animal Rescue Service (M.A.R.S.) provides all medical care required by the animals in the adoption program. Upon adoption, it is the sole responsibility of the adopter to continue to care for this pet both physically and medically. As a potential adopter of M.A.R.S., do you agree to keep an adopted pet up do date on medical care?*

I hereby certify that I am over the age of 18, and that the information entered on this application is true and correct. Enter your name and date*