UNITED MALTESE RESCUE ADOPTION FORM
Name: ________________________________________________________
Address: ____________________________ City: ______________________
State: _______________________________Zip: _______________________
Phone: ______________________________Email: ______________________
1. Why do you want a Maltese?
2. Have you ever owned a Maltese before? Y N When? Where did you get it?
3. What happened to him/her?
4. Who is this Maltese for? Self? Other? Who? Live with You? Y N
5. If single: ____ Live Alone? With Family?
6. If married/Living Togther: Do you both work? Y N Work Hours (husband/wife/partner) Occupation: Husband Wife Partner:
7. Do you have children in your home? Y N How many? Ages?
8. Who will be responsible for the Maltese?
9. Do you rent? Y N - Own? Y N - House? Apartment/Condo? Fenced Yard? Acreage/How much?
NOTE: If renting you must provide proof that you are allowed to have pets. This may be a letter from your landlord or a copy of your lease or both.
10. Do you plan to move in the near future? When_______ Where
11. Do you understand that a Maltese is an indoor dog? Y N
12. Do you have a pool?_____ Is it fenced?______
13. Are you aware of any distractions outside your yard that could be a hazard to the dog? (e. g., neighbors, dogs, unleashed dogs, mischievous children)? Explain
14. Can strangers gain access to your yard from the streets? Y N If yes, explain
15. Do you or anyone who lives with you have allergies to ANY animals? Circle ONLY One: Y N
16. Do you have other pets? Y N What kind? What sex?
17. Where did you get your pet(s): __________Breeder ____________Pet Store ___________Other
18. How long have you had him/her/them?________________________________________
19. If you don't have a pet now, have you had a pet before? Y N
20. What kind? How long did you have him/her? What happened to him/her?
21. If you have other animals, what problems have you had with them, if any?
22. If you have other dogs, would you consider them aggressive or submissive to people? To other animals?
23. If you have birds, rabbits, cats, etc., are you prepared to spend the time necessary to accustom them and the dog to each other? Y N
Can you isolate the dog from the other animals if they cannot get along? Y N
How do you plan to do this?
24. Are you willing to take time before acquiring a Maltese to read and learn about their temperament, socialization, grooming, potential health issues, and proper handling and to understand the amount of time/cost involved in caring for this breed properly? Y N
25. Have you done any research on the breed already? What kind?
26. Have you discussed the pros and cons of owning a Maltese with your family?___________
27. Have you asked yourself whether your lifestyle is so busy that you might not have the time or energy to properly care for a dog?
28. Is your lifestyle such that friends, relatives, and children gain admittance to your home, property, or car without your supervision?
29. If you have children, are you willing to accept the additional responsibility of caring for a Maltese? Y N
Have you taught your children the proper way to treat a living animal?
30. Does everyone in your family want a dog? Y N
31. What other breeds, if any, have you been contemplating?
32. What is your family's overall reaction to owning a dog?
33. Which family members are enthusiastic? Unenthusiastic?
34. What concerns, if any, have been voiced by other family members?
35. Do you realize that a Maltese may live for 10-18 years?
Are you committed to caring for the dog for its entire life?
36. A Maltese enjoys a daily walk, and, if properly conditioned, can even go hiking or jogging with you.
Have you and your family carefully considered how the dog would fit into your lifestyle? Y N
37. Are you likely to enroll your dog in obedience training? Y N
38. Are you willing to attend obedience classes to train the dog? Y N
39. Which family members would be expected to assist with training the dog?
40. What method would you use to discipline a dog?
What action on the part of the dog would lead you to discipline it (e.g., soiling, barking, biting, etc.)?
41. Would you prefer a male or a female? If so, which? M F Would you consider the opposite sex?__________________________________ If not, why?
42. Please Circle the YOUNGEST and the OLDEST age dog you would be interested in adopting. Ages: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+
43. Are you agreeable to returning the dog, to United Maltese Rescue should some unforeseen circumstance arise and you could no longer keep him/her?
44. Would you be willing to allow us to visit your home?
45. How did you find out about United Maltese Rescue?
46. If you are away for a few days or go on vacation who will take care of your Maltese?
47. Are you aware that a rescue Maltese may require some housetraining and are you willing to work with the dog to housebreak it?
48. Will you adopt a Maltese dog that has been abused or has medical problems? Y N
49. Will you adopt a Maltese dog that is known to have a biting problem, i.e. with children or adults?
50. Please list TWO character references we may contact. Please provide name, phone number, and email address if available.(1) Name:____________________ Phone:____________________ Email:____________________
(2) Name:____________________ Phone:____________________ Email:____________________
51. Please provide a veterinary reference if you currently have pets or have had in the past.
Name:_______________ Address:________________ Phone:_______________
Your Name:____________________
(please print)
Signature:_____________________________________Date:__________________
WE RESERVE THE RIGHT TO REFUSE AN APPLICANT
Thank you for contacting United Maltese Rescue. We do our best to match the available dogs to the needs of the adopters; however, our primary interest is always the well being of the Maltese and our decisions are based on the dogs' needs.
If your application is accepted and you adopt a Maltese through our organization, there is a $250 adoption fee, payable at the time you bring the dog into your home. PLEASE NOTE: There is a $25 return check fee if your check is returned to UMR for ANY reason. We would also appreciate a $10 donation along with your application to help us defray expenses for our rescues. United Maltese Rescue is a Non Profit 501 (c) 3 organization.
Please mail this application, along with any donation to one of the following:
Lee Oden
6610 Pebble Court
Frederick, MD 21703Barbara Fine
105 S. Jefferson St.
Middletown, MD 21769Debbie Birtwistle
13127 Bradley Farm Drive
Oak Hill, VA 20171Thank you for your cooperation. This comprehensive questionnaire helps us in placing the right dog with the right family. An improper placement, or one in which all the details aren't known, can end tragically, usually for the dog.