This form is an example of what might be used if you choose for the prospective home to complete something formally and in writing. It is highly recommended to do this, so you have answers to the questions highest on your list for this ME dogs home.

We require an adoption application, home visit, and vet references. Our ME dog is very special to us and we want to make sure the new foster or forever home is a loving, safe, happy environment. Contact us to get more details on our ME dog.

Please answer the following questions before deciding on this special needs dog. This will hopefully ensure the best possible match between our dog and you as a foster or adopter. Remember that this is a lifetime commitment. You will be asked to sign a legal contract when adopting our dog.

Keep in mind the following points:

• The foster or adopter must help with transport if not close proximity (see transport options link).

• Dogs must be kept indoors. An onsite home visit is required unless someone from the ME groups knows you personally and can provide reference to that affect.

• ME dogs can live an average of 10 – 12 years. We are looking for that special foster or adopter who will make every effort possible to keep this ME dog for the entire life despite life style changes (divorce, moving, etc).

• Dogs will not be placed in a home where there is an unneutered or unspayed dog for the safety of all.

• We cannot adopt dogs to children. An adult must sign the adoption contract. Please do not have your children call or email. Applicants under 18 years of age must have a parent or legal guardian apply on their behalf.

Foster or Adoption Application

MUST complete as much information as possible for consideration

Dog’s name you wish to foster or adopt:

Fostering or adopting (circle one): ADOPT FOSTER

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Personal Information

Name:

Street Address:

City:

State:

Zip/Postal Code:

Home Phone:

Work Phone:

Mobile Phone:

Email Address:

Name and Phone Number of person who can always reach you who does not live at the above address:

Where do you live?

Do you own or rent?

How long have you lived at this address?

List all human members of household including ages of children:

Does any member of your household have any known allergies to animals? If yes, please describe:

Do we have permission to visit your home? If no, explain why?

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Megaesophagus Specific Information

Are you familiar with Megaesophagus?

How and in what capacity?

Are you willing to join an ME support group to post and receive advice from others if/as needed?

Do you know anyone who has or has had an ME dog?

List name(s):

How long have you known them and did you ever see them managing their ME dog?

Can you financially accept whatever comes your way with this ME dog?

Is there a limit?

Are you committed to taking full responsibility for your dog’s health and welfare for the rest of its life, which could be 10 years or more?

Are you willing to research and learn as much about ME as you can to keep your dog’s ME managed? (many times the protocol may need to change and quickly)

Are you familiar with aspiration pneumonia (AP), its signs, symptoms, causes, etc because this can cost our ME dogs their lives?

What would you do if AP was suspected in this dog?

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Pet History

Do you currently have any other pets? If yes, please describe (include all animals including roommates’ animals), type, age, sex, spayed/neutered, kept indoors or outdoors, had how long?

Your veterinarian’s name:

Veterinarian’s telephone number:

List pets owned in the past 10 years, other than those listed above. Include type, age, sex, spayed/neutered, kept indoors or outdoors, had how long, when you stopped owning the animals

and reason.

Have you ever taken an animal to the shelter? If yes, what were the circumstances? Do you anticipate moving soon? If yes, when?

Dog-specific Questions

Please state reason for wanting a dog as a companion:

If you have any preferences as to breed type, gender, age, size, length of hair, what are they?

I need a dog that gets along with: (children, other dogs, other people, cats, birds, etc)

I want my dog to be by my side when I am home?

I want my dog to be the type that is very enthusiastic in the way it shows affection?

When it comes to a dog lying on the furniture, I would?

When it comes to a dog sleeping on the bed, I would?

I want my dog to be playful?

I would like my dog to participate in what hobbies or activities with me?

I prefer a dog whose energy level is:

What else are you looking for in a dog?

Do you have a fenced yard?

If so, how high is it, what is it made of, what kind of gates, and what size is the yard?

Is your home usually quiet, has some activities and visitors, or are people come and going all the time?

How much time per day will you be able to interact with your dog?

If you suddenly relocated or had other drastic lifestyle changes that made it hard to keep your dog, what would you do with it?

Who will care for your dog when you go out of town, or in case of an emergency?

If your dog becomes seriously ill or injured and your veterinarian says expensive medical treatment is needed, what will you do?

Do you plan to have your dog spayed or neutered (if not already done)? Why or why not?

Have you ever lost a pet? What did you do to find him/her?

Where will the dog be kept while you are away?

Where will the dog sleep at night?

How will you keep this dog confined to your property?

You may have to housetrain your new dog. Have you done this before, and how long do you

expect it to take?

Have you ever completed an obedience class with your current or previous dogs? Do you plan on

taking the new dog to obedience training? If so, where?

What will you do if the dog chews furniture or demonstrates other destructive behavior?

Are you familiar with heartworm disease?

Will you use flea/tick prevention? What kind?

Will you use Heartworm prevention? What kind?

Are you familiar with leash and licensing laws in your community?

Will your dog be leashed at all times if not inside your house or in your back yard?

Comments that you wish to add in addition to above information that will help us determine this is the right home for our ME dog: