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
Please select from the list below of available animals. If you don't see the name of the animal you are interested in, please contact us for more information!
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.