Marilyn's Voice, Inc

Your application will be answered as soon as possible.
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Name of dog interested in:  
First Name: Last Name:
Street Address:
City: State:
Postal Code: Country:
Home Phone: Work Phone:
Cell Phone: Fax Number:
NOTE: If you do not provide your phone number, your application will be discarded.
Best Time to Call: Prefered Number:
E-mail: Occupation
How Long at
Present Job? 		If less than 1 year, please state how long at your previous job?
PERSONAL REFERENCES: (other than a family member) who are familiar with your
experience as a pet owner:
Reference 1:      
Full Name: Relationship:
Phone #: Alternate Phone#:
E-mail: Best Time to Call:
Reference 2:      
Full Name: Relationship:
Phone #: Alternate Phone#:
E-mail: Best Time to Call:
NOTE: If renting, you will need to provide a copy of your lease/co-op bylaws to the
rescue representative before adoption.
Do you own or rent your home? Own Rent Other
If renting, do you have your landlord's permission to keep a dog? Yes No
Landlord's Full Name: Landlord's Phone:
Do you live in a:  How long have you lived at this address?
NOTE: If you live in a condominium/co-op, or your house is a part of a homeowner’s association, prior to adoption, you will need to provide a copy of the bylaws, rules and regulations of such association stating that there are no restrictions regarding owning a dog. If there is a limit on the number of pets you are allowed, please note the limit on the copy of the bylaws.

Do you have a fenced yard?

Yes No Does the fencing completely enclose a yard for the dog? Yes No
Fence Height: Fence Type:
If no fence, how will you handle the dog’s exercise and toilet duties?
Do you have a separate kennel run? Yes No
List height and size:
Height Size Height Size
Height Size Height Size
How many adults in household? How many children?
Age of children:      
Are all family members in agreement about adopting a puppy mill rescue and the extra work and patience that goes into it? Yes No
Are there regular visitors to your home (human or animals) with which your new dog must get along? Yes No
If yes, please describe:
NOTE: If you currently have or have had a pet within the last five years,
please provide a veterinarian reference.
Other animals in home? Do you have a regular veterinarian? Yes No
How long have you been with this vet? Vet Full Name:
Vet Street Address:
Vet City: Vet State:
Vet Postal Code:    
Vet Phone Number:  
If no Vet Reference, please provide a reason:
How many dogs have you owned in the last ten years?

For all dogs you presently own, give name, age, sex, breed and if spayed/neutered:

Give name, age, sex, breed, if spayed/neutered, and what happened to all dogs that you have owned in the past 10 years, but no longer have, listing the years you owned them:
Describe your ideal dog:
In your research of puppy mill rescues, is there anything about these dogs’ potential issues that might be an issue for you? Please describe:
Circle all plans for this dog: Pet Guard Dog Hunting Obedience Agility Other
What gender do you want to adopt? No Preference Male Female
Color Preference:  
Age Preference:  
Size Preference:  
I have marked my preferences above, but would be willing to consider a suitable dog of a different: None Gender Color Size Age
Where will the dog spend the day: 
Please explain “Other”:

Do you understand that Marilyn’s Voice requires this dog to be spayed or neutered?

Yes No
Do you agree to license this dog and give it regular health care? Yes No
Do you agree to contact Marilyn’s Voice if you can no longer keep this dog? Yes No
Would you be willing to allow someone designated by Marilyn’s Voice to visit your home by appointment? Yes No
If not, why?
How did you hear about our rescue efforts?
I am over 18 years of age Yes  No

Marilyn’s Voice does ask an adoption fee in order to help us cover expenses incurred. Prices on different dogs may vary depending on age and veterinary expenses we have incurred.  Please contact your local representative if you have any questions.

All of the above information I have given is true and complete. Should an unneutered or unspayed dog be placed with me, I agree to have it neutered or spayed by such date agreed upon by me and a Marilyn’s Voice representative. At that time, I will forward evidence to Marilyn’s Voice that such procedure has been completed.

This dog will reside in my home as a pet. I will provide it with adequate food, water, shelter, training, affection, and medical care. I understand that Marilyn’s Voice dogs are puppy mill rescues, and that the dogs available for adoption may have habits, temperament, or physical conditions not yet known at the time I adopt that dog.  While all Marilyn’s Voice dogs have seen a vet, some issues surface later and I understand that it is my responsibility to evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of adoption. Marilyn’s Voice shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, causes of action, fines, suits, demands, judgments or claims of any nature whatsoever arising from or by reason of any damage to property or injury to any persons caused in whole or in part by the dog placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold Marilyn’s Voice harmless from and against all of the aforesaid. Submitting this form constitutes your permission for us to check references.



WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE ANY APPLICANT FOR ANY REASON WHATSOEVER.

I have read the disclaimer and agree to these terms & conditions


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