MOMsVA Dog Rescue

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  • Friends of MomsVA
  • HOME
  • Find a BEST FRIEND
  • HELP the Dogs
  • JOIN the TEAM
  • HAPPY Tails
  • Friends of MomsVA

    MomsVA Animal Adoption Application

    Thank You for your interest in adopting a rescued canine orphan. Please give yourself ample time to complete this application. Our goal is to make lifelong matches for dogs and people.

    Because MomsVA is run solely by volunteers, please allow us time to review your completed application. We will contact you as soon as we can. 


    This form is confidential: This form is designed to help you find the dog or puppy most compatible with your lifestyle. MomsVA will maintain the information provided below as confidential and will not share your information with any outside individuals or organizations without your express consent. Completion of this application does not obligate you in any way or guarantee the adoption of a MOMS dog or puppy. MOMS reserves the right to approve or deny any application for any reason and the right not to disclose the reason.

    All dogs are spayed/neutered prior to adoption: All MomsVA adult dogs and puppies are spay/neutered prior to adoption.It is possible that an approved adopter may experience a short waiting period (for spay/neuter to occur) between being approved and being able to take the dog or puppy home. In the event this occurs, we thank you for your patience.

    Please complete all the following questions completely to the best of your knowledge.
    Be sure to complete questions with a red *. These items are required and your information will not forwarded to us if any of them are left blank. 

    Applicant information


    Household Information


    Current pets?



    Other previous pets?

    If you previously have had other animals/pets, please complete the following:

    Lifestyle Information




    Training and development




    References

    Please provide TWO personal references of someone not living in your home.

    AUTHORIZATION/RELEASE

    By signing (spelling out your full name on this form) below and submitting this form, I certify that all information given in this application is true and correct, to the best of my/our knowledge. By submitting this form, I hereby further grant consent to MOMS and its agents to seek information about me from all named and unnamed sources within this application, including but not limited to veterinarians, rental agents, and personal references, regarding this application. Providing false information or refusing to sign below will result in the rejection of the application or the nullification of the adoption agreement.
     Printing your name represents your official signature in the space(s) below.
    MomsVA reserves the right to approve or deny any application for any reason and the right not to disclose that reason.

    BEFORE you click SUBMIT, please note:  
    • Please check that you have completed all questions where there is a red * (these are required).
    • Once you have filled in all the * fields and hit SUBMIT,  wait until this page refreshes and you see a confirmation message that says your information has been sent to info.momsrescue@gmail.com for review.  We are not able to send confirmation emails at this time.  As long as you see the confirmation page, your information has been sent to us. 
    • If the page does not refresh, look for a message under the SUBMIT button that says "Please correct the highlighted fields."  Then go back through the application and fill in any item on the form where there is a red * and hit SUBMIT.  
    We look forward to receiving your completed form! 
Submit

Please consider helping the dogs through donation. Any and all amounts are appreciated. Every penny is used to rescue the dogs.
Ways to Help the Dogs
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