ADOPTION APPLICATION Michigan Doodle Rescue Connect

REVISED 01/2023
I understand that MDRC does not hold on to applications. I will follow the instructions listed on the
website._____
X I have read the website and know the matching adoption process.________
I
X understand that I
will submit my application following the post instructions________Everyone
X in my home has discussed
adopting a dog within the last month__________________________
YES

Full name: _________________________________________Spouse_____________________________(roommates

Mar yDRAUGELIS-DUSSEAU JAMES DUSSEAU must be listed)
Occupation (s): ______________________SPOUSE
retired nurse Occupation:_________________________________
retired electrician
How many hours do you work average?____________ 0 Spouse_________________
0

4345 12TH ST. PO BOX 191

Address: ______________________________________________________________ Moblie__________________________Home_____________________________
734-770-9606
CITY________________________STATE___________________ZIP_________________

LUNA PIER MI 48157

PIER
How long have you lived at this address: ___________________________
18 YEARS
Email address: __________________________________________________________
RUN2SUN16@GMAIL.COM

Previous Pet
Previous Pet History__________________________________________________________________________________________
several doogs over the years.our last dog was a rescue and we had to euthanize her a few
years ago at her sge of 15 due to pain/mobilityage related issues

Family & Housing

How many adults are there in your family (their relationship to you)?________
just us

Children and Ages________________________________

Describe home: single family, apartment etc.?_____________Is your house
SINGLE FAMILY household: __ Active __ Noisy __ Quiet __x
Average_____ Do you live on a busy street? YES______ NO____x
Does anyone in the family have a known allergy to dogs? YES______ NO______ x

Do you have a fenced-in yard? YES____ NO_____PARTIAL LY,THERE'S AFENCED IN FIELD NEXY TO OUR HOUSE
TYPE ( DO NOT LEAVE BLANK> EXPLAIN WHO THE DOG WILL GO OUT):
Aluminum Chain Link Fence____ Wood___Vinyl X _____Height________ 4FTLeash walk_______TIE
X OUT________
Invisible_________Brand_________

Where does your current dog stay while you are gone?______________________________________________
IN THE PAST, A DOGGYDAYCAREOR FAMILY
PETSITTER
Other pets do you have (specify breed and number)?
NO CURRENT PETS
_______________________________________________________________________________________________________________UTD on vaccines _________
Neuter/Spay______ Energy level: Low______
Moderate_______ High________
Have you ever surrendered a pet? If so, why?
_________________________________________________________________________________
NO

Have you ever had a pet euthanized? If so, why?
_________________________________________________________________________________
YES INOPERABLE BRAIN CANCER,
MOBILITY-PAIN ISSUES DUE TO AGE
Have you ever adopted and needed to return the dog for any reason?
__________________________________________________________________________________
NO

Have you ever adopted a dog and did a trial adoption?_______________________________NO

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What level of training are you comfortable with?

Low to moderate________
X (includes basic commands and leash walking)
Moderate to High____________ (includes basic commands, leash walking, potty training,
chewing, and some behaviors like jumping or excitement.)

Do you prefer a non shedding dog?__________
YES!
Why?___________________________________________________

One thing you would love about the dog you are applying for?
_______________________________________________________________________
COMPANIONSHIP, GO ON WALKS/JOGS IWE LOVE BEING OUTDOORS AND KEEOING ACTIVE
__________________________________________EVERYDAY

_______________________________________________________________________
__________________________________________
_______________________________________________________________________
___________________________________
I have experience training______________________________________

I love these qualities of a dog.________________________________________________
FRIENDLYDISPOSITION, SEEM TO GET ALONG WITH OTHER DOGS,
ADORABLE LOOKING AND NON SHEDDING
Something I want you to know about me and my
family.__________________________________________________________________
______________________________________________________
_______________________________________________

I want a dog under 50 lbs________ I want a dog over 50-100 lbs._________

MEDIUM SIZE

I don't care, I just want to adopt my match._____________

X
Tell us about you and why you want to adopt. HAD TO TAKE EARLY RETIREMENT IN 2020 ,I MISS
HELPING OTHERS,AND MY GRANDKIDS LIVE FAR
AWAY AND REALLYY WANT A DOG TO LOVE AND TAKE
CARE OF

Veterinarian
tEMPERANCE ANIMAL HOSPITAL
How many years?______
13 -14 YEARS
Veterinarian’s name:________________________________________
Clinic Name___________________________________________
TEMPERANCE ANIMAL HOSPITAL

Clinic Address:
734-847-6751
_________________________________________Phone:_________________________
7375 LEWIS AVENUE,TEMPERANCE MI 48182

____________
Personal References
Please list someone who is familiar with both you and your pets.
Name:
Address:
Phone: -734-4974093
Name: Address: Phone:
SONYA COMER,
______________________________________________________________________
4353 12TH STREET PO BOX 21 LUNA PIER MI 48157
_________
(Signature)
MD 01/31/23 (Date)
All above is true and I understand that any false information will
result my application being removed from MDRC files.

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