Adoption Application

To qualify for adoption from Tails of the Midwest Rescue you must:

• Be at least 21-years of age
• Be willing and able to spend the time and money necessary to
care for a new pet. Including but not limited to medical
treatment, nourishment, care and training
• Have consent from a landlord if applicable
• Cannot have a previous animal cruelty conviction


Please complete the form below

Applicants Name *
Applicants Name
Co-Applicant's Name
Co-Applicant's Name
Applicant's Address *
Applicant's Address
Applicant's Phone *
Applicant's Phone
Co-Applicant's Phone
Co-Applicant's Phone
What type of home do you live in? *
Do you *
Does your residence have any pet restrictions? *
Tell Us About Your Current Animals:
* Please note, all other pets must be update to date on vaccinations before an adoption would be approved *
For what reason(s) would you consider giving up your pet(s):
(Check all that apply)
Tell Us About Your References:
Immediate family to you or anyone in your household will be not be considered.
Reference One's Name *
Reference One's Name
Please provide a references that are familiar with your family and any current pets.
Reference One's Phone Number *
Reference One's Phone Number
Reference Two's Name *
Reference Two's Name
Reference Two's Phone Number *
Reference Two's Phone Number
By clicking "Submit" below, you agree that all the information above is true and complete.