First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

Are you applying to adopt or foster (foster only, not intending to adopt)?*

Date (example 01/01/2019)*

Occupation (EX: electrician, retired, unemployed, stay at home mom/dad, military, etc): *

Employer: *

If you are active military are you subject to deployment?*

If your spouse/partner is active Military, are they subject to deployment?

Spouse/partner full name (if none, please write none): *

Spouse/partner Occupation (EX: electrician, retired, unemployed, stay at home mom/dad, military, etc). If none, say none. *

Spouse/partner Employer (if none, say none): *

Do you have a Facebook Page? If yes, what name is the page found under?*

Do you have an Instagram Account? If yes, what name is the page found under? If no, answer no. *

Do you have a TikTok Account? If yes, what name is the account under? If no, answer no.*

Does your partner have a Facebook page? If yes, under what name? If none, say none.*

Does your partner have an Instagram account? If yes, under what name? If none say none. *

Does your partner have a TikTok account? If yes, under what name? If none say none.*

Please list the name, age and relationship of ALL people living in the home (including the applicant): (Example: Bob Smith, 57 years old, father-in-law)*

Does anyone living in the home have pet allergies?*

If someone living in the home has pet allergies what are they allergic to?*

Name of ABMR coordinator you are working with (if any), if none say none.*

If you are applying for a specific dog what is their name?

What sex Malinois are you interested in?*

Please list all dogs you have owned in the past 10 years. (Please use this format) Name Breed Age Sex (M/F) Neutered/Spay (Y/N) Alive/Deceased (A/D) Example: Buffy Malinois 10 years F Y A If none, say none*

What other pets do you currently own (cats, chickens, birds, horses, etc. and how many of each)? If none, say none.*

If you have adopted from American Belgian Malinois Rescue in the past please provide name of the dog, date of adoption, and name of the coordinator who handled the adoption. (example: Buffy 1/1/2020 Coordinator Jane Doe)

Which do you live in:*

Do you rent or own?*

Landlord’s Name:

Landlord's Street Address

Landlord's City

Landlord's State

Landlord's Phone

Landlord’s Email:

Are you planning to move in the near future?*

Do you have a 2nd home/vacation home, if yes, please give address.*

Is your yard fully fenced? *

If your yard is only partially fenced please explain (height, how many sides, back yard only, etc)

If you are part of a Home Owners Association please provide the HOA phone number.

If you are restricted by local ordinances to a certain number of dogs, what is that number?

Have you ever bred dogs?*

What family activities and dog sports would you like the dog to participate in? *

Who is primarily responsible for the dog?*

How much time would the dog spend alone (without human companionship) on a daily basis (approximate hours) or on a weekly basis (approximate hours per day left alone and how many days). How do you plan to care for the dog if away for more than 4 hours? *

Would you supervise the dog while outside at all times? (including fenced in area)*

What conditions would cause you to give up a dog?*

Please provide information for the veterinarian who provided your pets most recent vaccinations. Vet Name:*

Vet Street Address:*

Vet City:*

Vet State:*

Vet Zip code: *

Vet Phone Number:*

Name under which pet records can be found at this facility:*

First Personal Reference NAME: (MUST BE A NON-RELATIVE and cannot live at the same address as the applicant, someone you have known for at least 2 years and have seen you interact with your dog/pets) PLEASE NOTIFY THEM THAT WE WILL BE CALLING. *

1st reference email:*

1st reference phone number:*

1st reference Time Zone or State of Residence:*

Second Personal Reference NAME: (MUST BE A NON-RELATIVE and cannot live at the same address as the applicant) PLEASE NOTIFY THEM THAT WE WILL BE CALLING. *

2nd reference email:*

2nd reference phone number: *

2nd reference Time Zone or State of Residence:*

Third Personal Reference NAME: (MUST NOT live at the same address as the applicant but may be a relative or non-relative) PLEASE NOTIFY THEM THAT WE WILL BE CALLING. *

3rd reference email: *

3rd reference phone number: *

3rd reference Time Zone or State of Residence:*

Please indicate you are aware that a dog adopted through ABMR MUST be returned to ABMR if you are unable to keep it.

Please confirm your understanding that submission of this application does not mean that you will be approved. We reserve the right to reject any applicant for any reason.

You understand your vet and personal references, including landlord (if applicable) will be contacted, and that a home visit will be required (either virtual or in-person at our discretion) to complete the application process. All family members (both human and pets) living in the home must be present for the home visit.

Do you confirm that all the information provided on this application is true and correct?*

By submitting this application, you acknowledge that you understand and agree to the following: 1) You are 21 years of age or older. 2) Protection training and bitework are not allowed with any ABMR dogs. 3) Fostering means there is little known about the dog prior to coming to you from any source (shelter, stray, owner surrender, etc). 4) Whether adopting or fostering and ultimately adopting the dog, you understand that there is an adoption fee that will be between $325 and $475 depending on the age of the dog. 5) If adopting a puppy that is too young to spay or neuter, you will be required to put a $500 spay/neuter deposit down that is returned once proof of spaying/neutering is provided. 6) Transport - As an adopter you are required to meet your dog a minimum of halfway on transport. With rare exception we do not place dogs in CA, WA, OR, ID, MT, UT, Mexico, or Canada. 7) An incomplete application will be automatically rejected. Please answer as fully and completely as you can so that we may quickly and efficiently process your application. Be sure the application acknowledges submission and that you receive a Welcome Letter upon submission of your application.

Applicant Name:*