Adoption Survey

Please take the time to read our Adoption Requirements thoroughly.

Due to the current coronavirus/COVID-19 situation, out of an abundance of caution, and following direction from the CDC and the IL Department of Public Health we have put in place certain expectations and guidelines.
The health of our volunteers and adopters comes first during this time of need.

We will continue to do adoptions during this time, with the following modifications to our process:

Home visits will be performed following public health guidelines and allows for 6 feet of “social distancing” between all attendees.

All attendees must wear masks.

Please be forthright and let us know if you have traveled in the last 14 days, have a fever, sniffles, cold or flu-like symptoms, sore throat, or cough.
We will work with you to reschedule or provide alternative meeting arrangements.  Failure to adhere to our requests will result in denial of adoption.

We do require an at home visit with all members of the family that reside in the home including all other pets.
Please note that we are adamant about the distance that we are willing to travel with our rescue animals and volunteers.  We will automatically reject applications that are over 25 miles away from where the animal is located.

Submitting an application does not guarantee placement or hold of any of our rescued animals.

Adoption Survey

Contact Info

• Name of Animal and breed that you are interested in if available.
• Your Name *
• Your Address *
• City *
• Zip Code *
• Your Email Address *
• Your Phone Number *
• Alternative Phone Number
• Best way and time to reach you. *
  Please check all that applyEmailPhoneMorningNoonEvening

About You

• Are you over the age of 21? *
  YesNo
• Employment Status *
  Please check all that applyFull-timePart-timeStudentUnemployedHomemakerRetired
• Employer Info *
• How many hours a day would the animal be left alone?
• Type Of Residence *
  Single Family HomeTown House/ CondoApartment
• Do you *
  Own?Rent?
• If you rent, can you provide documentation that you are allowed to have pets?
  YesNo
• Landlord or Association Info
• What type of yard do you have? *
  FencedInvisible FencingUn-FencedNone

About your Household

• With whom do you live with? *
  Please check all that applySelfSpouse/ Significant OtherChildren under the age of 18ParentsRoommates
• Are the adults in your household aware that you are interested in adopting and will they give their consent?
  Please know that all persons and living in your home must be present for home visit.YesNo
• Please list all other members of your household over the age of 18, and relation to you:
• Number of children in your household under the age of 18, their age and relation to you. If you do not have children, please enter the number "0" *
• If you do have children, have they had pets before?
• Does anyone in your household have allergies? Please list:

Pet Information

• Please tell us about your current pets. Breed, sex, age
• Please tell us about your previously owned pets. Breed, sex, age
• Are your current animals fixed, as in spayed/ neutered? *
  YesNo
• Are your current animals up-to-date on vaccinations and can you provide proof?
  YesNo
• Have you ever had to surrender or give an animal away? What were the circumstances? *
• Do you plan to move within the next 6 months to a year? If yes, what do you plan to do with your current pet(s)?

Experience

• Please Check all that areas that you have experience in
  Fostered an Animal for a rescue.Transported An Animal for a rescue.Basic Obedience TrainingAdvanced TrainingHousebreakingBehavioral IssuesHospice CareNursing An Animal back to good healthBully BreedsLarge breedsSmall BreedsOther
• If you have adopted or worked with a rescue before, please provide their contact info:
• Please tell is why you would like to adopt an animal.
• How did you hear about Making A Difference Rescue?

References

• Please provide a veterinary reference. If not applicable, please explain why: *
• Please provide the name and phone number of TWO character references we may contact. (not a relative) *
• Would you be willing to allow a Making A Difference Rescue representative to visit your home after adoption? *
  YesNo
• General Information Please realize that Making A Difference Rescue does not have ANY paid employees.
  All time, gas and transport is donated out of pocket by each individual MADR volunteer.
  Due to time, costs of travel, and the requirement of a home visit, please realize that we are not able to adopt our animals out of state.
  At our discretion, we may decline an inquiry due to distance, etc.

   

  I have read and understand the following regarding the adoption process:
  -The rescue adoption process is not a fast one. We do our best to contact prospective adopters within 72 hours.
  It may take several days to several weeks for Making A Difference Rescue to screen check, and coordinate a home visit.
  We understand the urgency and excitement involved in adopting an animal but we can not return texts, phone calls or emails while working our regular non-rescue jobs.
  - A typical rescued animal may have one or more issues that need to be considered.
  Adoptive families need to be open to accepting an animal that is less than perfect; and - Even after my home visit is conducted, MADR may decide that their rescued animal is not appropriate for my family.

  In addition, all information in this application form is true and correct, and I understand and agree to abide by the terms and conditions herein.
  I understand that any misrepresentation of the facts may result in my not being approved to adopt an animal or the removal of the adopted animal from my home by Making A Difference Rescue

• Date *
• Digital Signature *

 

Verification

• Please enter any two digits with <strong>no</strong> spaces (Example: 12)*
• This box is for spam protection - <strong>please leave it blank</strong>: