Adoption Application

  1. Name of dog interested in:
  2. Your Name:
  3. Address:
  4. City:
  5. State:
  6. Zip:
  7. Home Phone:
  8. Cell Phone:
  9. Work Phone:
  10. Email Address:
  11. Best Time to Call:
  12. How did you hear about us?
  13. Age range and gender of adults in household:
  14. Occupations:
  15. Age and gender of children in the household (anyone under 18 years old):
  16. Do you plan on having children in the next 5 years?
  17. Are any members of your household allergic to animals?
  18. Are there other visitors to your home, human or animal, with which a new dog will have to interact?
  19. Do you live in a House, Apartment, Trailer, Other (Describe)?
  20. Describe your property (busy street, acreage, etc.):
  21. Do you own or rent your home?
  22. If you rent, do you have landlord's permission to keep a dog?
  23. Name of Landlord:
  24. Phone No:
  25. How long have you lived at this address?
  26. Do you plan on moving in the next few years?
  27. Do you have a completely fenced yard suitable for a dog?
  28. Do you have a kennel run or tie out for a dog?
  29. Describe fence, kennel run type or tie out (height, size, intended use):
  30. If no fence, how will you handle exercise and toilet needs?
  31. Do you have a suitable dog crate?
  32. How many hours a day must the dog be alone?
  33. Where will the dog be if left alone?
  34. Are you planning to enroll the dog in obedience/training class?
  35. Who will be the primary care give for the dog?
  36. Describe a typical day in the dog's life with you and in your home:
  37. What activities do you plan with this dog?
  38. Do you intend to keep this dog primarily inside or outside?
  39. Where will the dog sleep?
  40. Why have you decided to adopt a dog?
  41. Why did you choose this dog?
  42. Have you had a rescue dog before? If yes, describe your experience:
  43. Please list the dogs and other animals currently in your home (age, sex, breed, temperament, socialization with dogs). This question must be answered in full.
  44. Are the animals currently in your home neutered or spayed?
  45. How many dogs have you owned in the past five years that are currently not in your home?
  46. Why do you no longer have them?
  47. Have you ever adopted a dog from another rescue agency and were unable to keep it? Please tell us what happened in detail.
  48. Please tell us what the 5 most important traits in a dog that are important to you:
  49. Do you realize that a dog can cost in the upwards of $600 a year between regular vet visits and food. This amount does not include emergency trips to the vet office for those un expected situations. Are you able and willing to take on that financial responsibility?
  50. Do you realize that owning a dog is a 15 - 20 year commitment?
  51. Do you have a regular veterinarian?
  52. Name:
  53. Address:
  54. Phone Number:
  55. Would you be willing to consider a suitable dog of a different sex, age or breed (be specific)?
  56. Personal Reference
  57. Name:
  58. Relationship:
  59. Phone:
  60. I agree that all of the information I have given in this adoption form is true and complete. I agree that this dog will reside in my home. I will provide the dog with adequate food, water, shelter, training, affection and medical care and the dog will not be tied out or on a run. I understand that the rescue is not responsible for the accuracy of information received about the temperament, habits or physical condition of the dogs available for adoption. However, all information provided is given in an effort to do the best in knowing a dog prior to adoption. Please initial ______________ (or type the word "YES")

Who We Are

This site supports a small group of people who try to help as many displaced puppies and dogs as possible. All of them are altered and updated on all vaccinations prior to going to a home.

We are a non-profit, no-kill rescue organization, dedicated to making life better for the homeless and unwanted dogs in Ohio. We are all volunteers who do the best that we can with the limited funds and resources available to us. We give the potential adopter as much information as we can, including copies of all vet records but we normally do not know the history of the dogs, as they are strays at the pound. Very rarely do we have owner releases. All dogs and puppies are spayed/neutered BEFORE going to their new homes, no exceptions.

This listing and it's administer is not responsible and/or liable for the outcome of any adoption made through these listings as we are only providing information. This listing and it's administer are also not responsible and is held harmless for the accuracy and reliability of the information provided within these listings.Adopters bear the full responsibility and liability for any dog listed.

How can you help?

There are 4 things you can do and everyone can do at least one!

#1) WE ARE IN DESPERATE NEED OF FOSTER HOMES! Fostering is a great way to have a dog without out all the added expense. Not to mention you are actually helping to save a life!

#2) Donate items such as blankets, towels, food, collars, leashes, toys, dog beds, sheets, treats, etc.

#3) Volunteer to pull dogs from shelter or transport dogs to safety.

#4) The most important thing you can do and EVERYONE should do.

EDUCATE people on the option of adoption!

How to adopt

The adoption fee for all dogs listed depends on the breed, age, vet care, cost to pull from the kill shelter, worming medicine, flea medicine, etc. We do our best to keep the adoption fees as low as possible but this is how we cover our expenses.

All adopters must fill out an application. You may copy this application on this page into an email, fill it out completely, and email it to

We reserve the right to refuse any applicant for any reason if we feel the needs of the dog will not be properly met or the adoption is not in the best interest of the dog.

Please make sure you completely fill out the application before submitting it to us. All fields are required.

The application and adoption processes are designed to match appropriate homes with appropriate dogs. While many dogs may be attractive to the eye, we are very careful to understand the lifestyle of each adopter since we clearly understand the individual needs of dogs in our care.

We do not ship dogs; we require that the applicant come to meet the dog and us before an adoption will be made.

Our goal is to place dogs in happy, forever homes where the adopting party and dogs are both winners.


Click here to view a list of our adoptable dogs!Our dogs are located in foster homes throughout the State of Ohio. If you would like to meet one of our dogs, please complete an application and we will contact you to make arrangements.

Midwest Small Dog Rescue
Elyria, OH

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