GENERAL ADOPTION FORM - Paws for Life USA

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GENERAL ADOPTION FORM Paws for Life USA 2015-02-15T22:02:50-05:00

Adoption Questions

Pet's Name
Your Drivers License Number
Pet's ID#
Date of Birth
Todays Date
Your Name
Current Address
City, State, Zip
Home Phone
Work|Cell Phone
Email
How long have you lived at the address above?
Do you Own or Rent?
Own Rent
Do you live in a. . . .
House Apartment Condo Mobile Home Duplex Townhouse
If you lease does your lease allow pets?
Yes No N/A
Is there a pet deposit?
Yes No Option 3
If there is a pet deposit-how much? And is it already paid?
If you lease- What is the name of your Complex and or Landlord
How many people live in the household?
Do you have a roomate?
Do all members of the household know you are planning to adopt a pet?
Yes No
What are the ages of any Children|Grandchildren in the household or that come to the house?
Are you 18years of age or older?
Yes No
Do you live with you parents of other relatives?
Reason for adopting this Pet?
Child's Pet Family Pet Companion Watch Dog Guard dog for Business Breeding Hunting Dog
Are you or your spouse currently employed or retired?
Working Retired
Are you interested in adopting for. . .
Yourself Family Someone Else
Will an adult be home during the day?
Yes No Part of the day
What is the longest period of time the pet would be home alone on the average day?
Who will be responsible for taking care of the pet?
If adopting a dog or puppy, what procedures will you use for housebreaking?
Crate Training Newspaper Rubbing Nose Swatting wtih Newspaper Outside Only Other
Please explain other
If adopting a dog or puppy, how will you handle scratching or destructive behavior?
Loud No No Can Water Gun Swatting with Newspaper Outside Only Other
Please explain other
If adopting a dog or puppy, what plans do you have for basic obedience training?
Videos Classes Books In home lessons None Other
Please explain other
How many cats and/or dogs have you owned in the past five years?
Please Note: Breed / Age / Spayed-Neutered / How Long Owned
Do you presently have pet insurance?
Yes No
Are your pets micro chipped?
Yes No
If they are micro chipped- with whom?
If you no longer have some or all of these animals, what happened to them?
Have you ever turned in an animal to an animal shelter?
Yes No
Where will pet stay during the day?
Where will pet stay during the night?
Do you have a fenced in yard?
Yes No
If so, how high is it? And what kind?
If you do not have a fence, how will the dog get exercise and use the bathroom?
For which of the following reasons would you give up your pet?
Moving New Baby Not getting along with children Not getting along with other pets Divorce Getting out of fence Behavior Issues Children lost interest Financial Aggressive Behaviors Got too big Too time consuming Allergies Barking Medical Problems Would never give up the dog Other
Please explain other
If you currently own a dog, is it on heartworm preventative?
Yes No
If yes, what brand?
Do you currently have a Vet? If so, what is the name of your Veterinarian | Veterinarian Clinic?
May we contact Vet?
Yes No
Phone Number of Current Vet.
Would you object to an authorized representative inspecting the animal and premises where the animal is being kept?
Yes No
Applicant Acknowledgement- By checking this box you acknowledge all information provided is true and accurate.
Yes
Date Application completed

Verification

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