How did you find out about Atlantic Maltese Rescue, inc.?:

Why do you want to adopt a Maltese or other toy breed?:

Who is the dog for (yourself,  spouse, child, parent, sibling etc.)?

ADOPTION PREFERENCES:

• Please list the names of any dogs available from AMR that you might be interested in adopting:
  
  

• Sex:
  Choose One Prefer Male Prefer Female No Preference Only male Only female

• Age:
  Choose One Puppy (almost never available) 1-3 years (rarely available) 4-6 years 7 years or over No preference
  
  
• What is the youngest you would accept: 
  Puppy 1 2 3 4 5 6 7 8 9 10
   
• What is the oldest dog you would accept:
  No Limit 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
  
  
• How far would you be willing to travel outside your area to get a dog? 
  Home City Home State New England Mid-Atlantic Southeast Whole of East Coast Other

  Please Explain any travel conditions:

   

  Atlantic Maltese Rescue is based on the East Coast. Our available dogs will be in Atlantic Coast States, but we will consider placement in approved homes in other regions of the country, depending on travel arrangements, among other things.
  

• Will you accept a pair of dogs that cannot be separated?
  Yes
  No
  Maybe with the following conditions:
  

• Will you accept a dog that needs housebreaking or other obedience help?:
  Yes
  No
  Maybe with the following conditions
   
  

• Will you accept a dog with treatable medical problems:
  Yes
  No
  Maybe with the following conditions
  

• Will you accept a dog that has been abused?:
  Yes
  No
  Maybe with the following conditions
  

• Any other conditions  or comments on adoption?:
  

YOUR HOUSEHOLD:

List ages and relationship to applicant:

Do you or any members of your household have any medical condition (including allergies) that might interfere with ownership of a new dog?

Yes
No
If Yes, please explain:

• Do you –
  Choose One Own a house Own an apartment Rent a house Rent an apartment

• Does your landlord, co-op or condo permit pets?
  Yes
  No
  

If yes, provide the name and phone # of your landlord or managing agent to verify:

Landlord/managing agent:
Phone #:

• Do you have a fenced yard?
  
  Yes
  No
  If Yes, please explain type of fence:

• Do you have a pool?

        Yes
        No

            What are the work schedules of all the adults in your home?

• Who will be the primary caretaker of the dog?

• Are you aware that dogs should have annual physical exams and immunizations and should be on monthly heartworm preventive medication?

          Yes
          No
          If no, Please Explain:

• Have you considered the costs involved and budgeted the funds required for both routine and emergency veterinary care?

        Yes
        No

• If needed, are you or another member of your family willing to attend obedience classes for your new dog?

        Yes
        No
        If no, Please Explain:

YOUR PET-OWNING HISTORY:

•   Have you ever owned a dog before?  

Yes
No     

If Yes, Please give a brief history:
                       

 

•   Are there any other dogs currently in your household?

            Yes
            No
                     

If yes, please list age, sex, whether altered, type/breed, how long owned and how obtained (Example: "3 y.o. male neutered collie; owned 2 yrs; from shelter")

              

• Are there any other types of animals (including exotics) currently residing in your household?

Yes
No

If yes, please list age, sex, whether altered, type, how long owned and how obtained (Example: "3 y.o rabbit, M unaltered, owned 3 yrs, from friend")

• If you have other pets are you prepared for the fact that all the pets may not immediately get along with a new dog?

  Yes
  No
  Maybe, under the following conditions:
  

• If you have (or have had) other pets have you had any behavior problems with them?

Yes
No
If yes, what were the behavior issues?

REFERENCES: (All references will be checked)

Please provide name, address and phone number of your pets’ veterinarian if applicable.

          Please provide name, address and phone number of your pets’ groomer if applicable.

Please provide name and phone number of two personal references (not relatives).

Thank you for taking the time to complete this questionnaire. We know it is lengthy, but it is an important part of the adoption process.  In order for us to receive this form please hit the Submit button. You will receive an email within a few days showing that your application has been received and sent along to the board for review. 

 

Inasmuch as is practical, each prospective adoptive home will be visited by a Atlantic Maltese Rescue, Inc. placement volunteer to evaluate its qualifications.

It sometimes takes several months before the appropriate dog is available for adoption. You should use this time to read books and gather information about Maltese and rescue dogs in general ("Second Hand Dogs" by Carol Lee Benjamin and "Save That Dog" by Liz Palika are good ones), surf the Internet for applicable sites and check out obedience classes in your neighborhood. Please be patient - this process is very important to us in making the right placement for both you and the dog. If, in the meantime, your circumstances change and you are no longer able to adopt a dog, please notify us. Please check our available pets page.