M&M Exotic Avian Rescue

289-925-5169
mandmexoticavianrescuesanc@gmail.com

Adoption Application
Which Pet are you interested in?
Applicant Information
Name:
Phone Number:
Address:
City: Province: Postal Code: Do you Rent or Own?
How long have you lived at your current address? If less then 2 years please explain why?

Are you in a House or Apartment? Does your Landlord authorize pets?

What precautions would you take to prevent any pets from escaping from your home? I.E. Birds flying out the window.

Home Phone # Cell Phone # Day Time Phone #

Age: Email: Number of Hours Worked each day?
Employer:
List Others Living in the Same House:
Name Age Do you have Allergies/Asthma? Are you Pregnant?

Does anyone in your home Smoke Cigarettes or Marijuana?

Do you Smoke inside or outside?
How would you describe your family: Nervous Calm Quiet Loud Scheduled Spontaneous
What is the level of activity in your home: Couch Potato Calm Average Activity Athlectic Adventurers
Have you ever surrendered a pet to a shelter or rescue?
If yes, please explain the circumstances.

Please list any current Pets:

Pet Type Name Age Socalized

Please list any past Pets:

Pet Type Age Explain why you no longer have this pet?

If you have any cats or dogs, have they all been spayed or neutered?
Have all your pets been vaccinated?

What circumstances might justify giving up a pet? (Please circle all that apply).
BABY DIVORCE MOVING ALLERGIES
SHEDDING MOLTING PLUCKING WANT TO TRAVEL
PET ILLNESS TIME CONSUMING CHILDREN NOT INTERESTED HOUSEHOLD MEMBERS DISLIKE PET
PROBLEMS WITH OTHER PETS HOUSE SOILING BITING
NOISY MESSY COST NONE
OTHER, PLEASE EXPLAIN

What would you enjoy doing with your new exotic pet?
Are you willing to seek advice from an M&M Rescue representative if your pet exhibits any behavioral issues?

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Are you willing to bring your pet to the vet for a yearly exam?
Approximately how much do you think your pet will cost your per year:
Vet Bills: $
Grooming (I.E. Wing Clipping/Beek trim/Nail Trim): $
Food: $
Boarding or Pet Sitting: $

Why do you want to adopt this pet?

How many hours per day do you have to spend with your pet?
Where will this animal stay when you are at home:
Where will this animal stay when you are away from home (at work):
Where will this animal stay when you are on vacation:
What kind of food will you be feeding your pet?
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2
3
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5

Would you allow M&M Rescue to complete a home visit to complete the adoption process?
Would you allow M&M Rescue to periodically drop in for a home visit within the first year of adoption?
Yes or No If no, please explain why:

References
Personal References (Not related to you)
Name Phone Relationship Good Time to call

Vet References (Required) **

Name Phone Address Specialty

** Please inform your vet(s) that M&M Rescue will be calling and give permission to release information to us.

Signatures
By signing below:
1 I certify that the informaiton I have given is true and recognized that any misrespresentation of facts
may result in the loss of adoption privileges with M&M Rescue.
2 I understand that M&M Rescue has the right to deny my request to adopt an animal
3 I authorize investigation of all statements contained in this application.

Print Name Signature Date

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