American Maltese Assocation Rescue © 2011-2017   •  All Rights Reserved
Website developed and  maintained by Website to the Rescue
Logo design by Lori Lengen
The answers you give on this application will help us find the best possible match between you and the dogs available through the AMA Rescue Program, hereafter called Maltese Rescue.  Please fill out the form completely and double check its accuracy before submitting.  If you are unable to complete this online application or if you would prefer to fill out a printable application and mail it in, you can do so by clicking here.

PLEASE NOTE:  Your application may be denied if you do not complete the Required Fields as noted.
Adoption Application Questionnaire
PERSONAL AND HOUSEHOLD INFORMATION  
Applicant Name (REQUIRED) First Name:   Last Name:
Co-Applicant Name First Name:   Last Name:
Addressss
City
Zipcode
Email Address (REQUIRED)
Home Phone Number: (REQUIRED)
Work Phone Number:
Cell Phone Number:  (REQUIRED)
Best time to calll
Occupation/Work Place
Your Age and Co-Applicant Age
Name(s) of other Household Members
Age(s) of other Household Members
Do you have children or grandchildren, other than those living at your home, that would be visiting frequently?
Briefly tell us why you want to adopt a Maltese:
   

 

HOUSING  
What type of home do you live in?

If Other, please explain:

Do you rent or own your home?
Do you have a fenced yard?
What type of fence?

If other, please explain:

What is the height of the fence (at it's lowest point)
If no fence or on rainy days, how will the dog get exercise or relieve itself?
Does your home have a swimming pool?
If Yes, it is fenced?
Do you have any restrictions regarding pets in your association or neighborhood?

 

PREFERENCES  
Briefly describe the dog you would like:
(age, gender, personality, etc.)
Is there a particular dog we have available for adoption that you are interested in?    If yes, which dog?
Are you willing to adopt a dog that may have experienced some form of abuse or neglect that might require extra patience and training to get over some shyness and/or fears?
Are you willing to adopt a dog that has special medical needs and might require a special diet, medications (a pill, eye or ear drops) etc.?
Are you willing to consider a Maltese mix?
Have you owned any Maltese before?

 

 
How will the grooming needs of a Maltese be met??
if you were unable to care for the dog any longer, are you willing to return to AMAR?
How many hours, on an average, will this dog spend alone??
Where would this dog be kept during the hours it is left alone?
Where would this dog sleep at night?
How long will your Maltese be left outside?
Who will have primary responsibility for caring for this dog?
Does anyone in your home have allergies?    If yes, please explain:
Are you willing to re-housetrain your Maltese during the transition period in your home?
We cannot guarantee a dog is 100% housetrained. Most have begun housetraining in their foster homes; however, ALL dogs will have to be re-trained to some extent at their adoptive homes, due to a new sleeping and feeding routine. This not just for rescue dogs, ANY dog going to a new home will have to be re-trained at least to some extent!
Describe your previous experience training a dog?
Who will take care of your dog when you are out of town or on vacation?

 

PET OWNERSHIP HISTORY  
Do you currently own other dogs?     
Current Dog 1:  
Name:
Breed:
Gender
Spayed/Neutered
Age:
Weight:
How Long Owned?
What year did you get this dog?
Where is this dog kept?
   
Current Dog 2:  
Name:
Breed:
Gender
Spayed/Neutered
Age:
Weight:
How Long Owned?
What year did you get this dog?
Where is this dog kept?
   
Current Dog 3:  
Name:
Breed:
Gender
Spayed/Neutered
Age:
Weight:
How Long Owned?
What year did you get this dog?
Where is this dog kept?
   

Do you have any other pets??   If Yes, please describe:
   
Have you owned any dogs in the past?
If Yes, please provide information below:
Past Dog 1:  
Name:
Breed:
Gender
Spayed/Neutered
Age (when you last had this dog):
How Long Owned?
What happened to this Dog?
   
Past Dog 2:  
Name:
Breed:
Gender
Spayed/Neutered
Age (when you last had this dog):
How Long Owned?
What happened to this Dog?
Past Dog 3:  
Name:
Breed:
Gender
Spayed/Neutered
Age (when you last had this dog):
How Long Owned?
What happened to this Dog?

 

REFERENCES  
   
Veterinarian/Clinicc  
Name
Address
Phone
Best time to call
   
Groomer  
Name
Address
Phone
Best time to call
   
Personal Reference  
Name
Address
Phone
How does this reference know you?
Best time to call
   
Landlord  
Name
Address
Phone
Best time to call

 

CERTIFICATION  

By initialing here: and submitting this application, I agree to the following statement:


To validate human entry of this application, please type in the breed of the dog shown in this image in the box below::


(Hint:  It's a Maltese)

Would you like to join our Mailing List?

Upon submission, you will be directed to print out and sign our Application Certification and provide the signed Certification to an AMAR volunteer.


WE RESERVE THE RIGHT TO REFUSE AN APPLICANT
Thank you for contacting Maltese Rescue. We will do our best to match the available dogs to the needs of the adopters; however, our primary interest is the well being of the Maltese.