Memory of Monroe Scottie Rescue Online Application
First Name
Last Name
Email
Address
City
State (Two letter abbreviation)
Zip
Phone
Mobile
Preferred gender	--None--Male Female Either
Elderly or special needs?	--None--Yes No Depends on situation
Consider two Scotties that cannot be separated?	--None--Yes No
Consider a Scottie mix?	--None--Yes No Depends on the dog
Have you owned a Scottie previously or are a current owner?	--None--Yes No
Explain why you want a Scottie This must be filled out for every application.
I live in a	--None--Apartment Condo House Mobile Home Townhouse
My home is	--None--Owned Rented Other (Explain in Additional Notes)
Fenced in yard	--None--Yes No Partial
If you answered "Yes" above, please describe fence
Own a pool	--None--Yes No
Applicants age range	--None--18 to 21 22 to 35 36 to 45 46 to 55 56 to 65 66 to 75 over 75
Children (Highlight all that apply)	Adult Children Grandchildren Teenager Young Children Young Teen None
Children's ages
Number of adults in household
Where dog will stay (days)
Where dog will stay (nights)
Hours alone per day	--None--0-2 3-5 6-9 10-12 Over 12
What would you do with the rescued Scottie if you go on vacation
Other pets you currently own (select all that apply)	Dog Cat Multiple Dogs Multiple Cats Bird Reptile Fish Other
Pets you used to own - please list breed and reason you no longer own
Veterinarian name, address and phone
Personal reference #1 - please list name, address, email address and phone and how you know this person
Personal reference #2 - please list name, address, email address and phone and how you know this person
Additional notes - anything else you'd care to share about your environment, desire to own a Scottie or other information on your application.  Please note here if you are interested in a particular dog we currently have in our program.
By submitting this application, I affirm all the information I have provided is true and correct.  All household members (if applicable) are in support of the decision to adopt a rescue Scottie, and understand the commitment and financial obligations of doing so. I understand that by submitting this application, it does not guarantee that I will be offered a Scottie to adopt.  I agree to an in-home visit and reference checks if a Scottie becomes available for adoption that would fit with my household.  I also understand that I will be required to pay an adoption fee based on the age and condition of the Scottie.  I am at least 18 years of age and have the financial means of supporting a rescue Scottie.