Animal Name *

Animal Type *

Dog

Cat

Other

First Name *

Last Name *

Phone *

Email *

Co-Applicant

Street Address *

City

State

Postal code

Do you have other animals? List animal species, age, and if they are spayed or neutered. *

Current Veterinarian Informaiton

Veterinarian Name
Veterinarian Phone
Annual Vet Care Budget

Do you have children? *

Yes, I have kids at home.

Yes, I have kids visit my home.

No, I do not have kids.

List names and ages of other people in the home. *

How long at your current residence? (Number of Years) *

If less than one put 1 in field.

What is your living space? *

Home

Apartment

Condo

Mobile Home

Do you rent or own your residence? *

I own my residence

I rent my residence

I do not have a residence

What are you not willing to tolerate with the animal? *

Why are you a good choice for a rescue animal? *

Why are you looking to adopt an animal? *

Companion for Adult

Companion for Child

Companion for Pet

New Pet after a death

Farm Animal Addition

As a gift

Describe what you are looking for in the animal? *

How many hours a day will the animal be alone? *

Are you willing to potty train? *

Yes, I am willing.

No, I am not willing.

I would like an animal already potty trained

Do you have a fenced yard or area? *

Yes, fully fenced area.

Yes, partially fenced area.

No, I have no fenced areas.

Describe your fenced area.

Will your animal be kept inside or outside? *

Inside Only

Outside Only

A little of Both

Are you prepared to care for the animal for their whole life? (10+ years) *

Yes, I will care for their full life.

No, I do not want them that long.

Have you applied for a rescue animal before? *

Yes with MARC

Yes with another organization

What else do you want us to know about you?

I agree to have my image or the image of my animal in the MARC social media posts and website. *

Yes, I agree.

No, I do not agree.

I consent to receive SMS notifications and alerts from MARC. Message frequency varies. Message & data rates may apply. Text HELP to (423) 240-9074 for assistance. You can reply STOP to unsubscribe at any time.

If you do not receive confirmation of your submission, it means you have missed a required field. Please scroll up and look for the missing item in red.