First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Which animal are you interested in
Choose an animal: Sammie

If you wish to apply for more than one animal, please fill in the names of who you'd like to apply for. Give a rank order for preferences or state both if applying for a pair.

What is your date of birth?*

Place of employment, how long have you worked there, and phone number*

Driver's License #, State, DOB, and expiration

What is the full name of your partner, spouse, or companion?

What is your partner's date of birth?

Spouse/ Partner employment, how long have they been employed there, and phone number

Do you own or rent your home*
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

What type of area do you live in?*
Choose one: Rural Suburb Urban

What is the approximate size of your living area (i.e. # of sq feet)

What is the size of your yard?*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence
Choose one: Privacy Chain Link Invisible

What is the height of the fence

If you rent, please enter your landlord's name, phone number, and if applicable, name of Community to verify pet security/deposit has been paid and number of pets allowed

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

Is there a restriction on the # of pets or type of pets you are allowed where you live?*
Choose one: Yes No Not applicable

Are there any breed, size, or # of pet restrictions where you live?*
Choose one: Yes No Not applicable

If yes, what are they?

Are you anticipating a move, pregnancy, marriage, new home, or any other major change anytime in the next few months? Explain*

How many people reside in your household*

Ages of children living in the household, and are they temporary or permanent resident(s).

How much adult supervision will there be between the pet and any children?
Choose one: Maximum Some Minimal None

If no children reside with you how often will the pet come in contact with children?

Does anyone living in your household have any kind of medical condition…allergies, suppressed immune system, diabetes, or taking blood thinners?*
Choose one: Yes No

If you answered yes to the previous question, what is the condition?

Who in the household will care for the pet*

If someone other than you are you willing to be somewhat involved in the care, raising, and training of this animal?
Choose one: Yes No

Where will the animal be kept when you are home*

Where will the animal be kept when you are not home*

Where will the animal sleep*

How much time will the animal spend alone, without human companionship, per day?*

Will the pet be allowed on the furniture?*
Choose one: Yes No

Will the pet be allowed on the bed?*
Choose one: Yes No

Is there an aspect to your home that an animal could affect (i.e. white carpets, antiques, wicker)? If so, what?

Are you often away for extended periods of time (i.e. travel)?*
Choose one: Yes No

What will you do with the pet when you travel?*
Choose one: Boarding at vet or facility Leave at home with other family Pet sitter at their home Pet sitter at your home Take with you

What temperament(s) do you want in your pet?

What activity level are you looking for?*
Choose one: High Moderate Low

Some animals are lively and curious in the house, they like to play with you and follow you around. Do you think an active pet would annoy you?*
Choose one: Yes No

How would you encourage, reinforce your animals appropriate behavior?*

How would you prevent, manage your animals inappropriate behavior?*

Why are you interested in adopting a pet at this time*

Are all members of your household aware you are adopting a pet?*
Choose one: Yes No

Has your dog been around cats before?
Choose one: Yes No

Have you ever owned a dog before? If so, how long ago?*

Are you planning to take your new dog/puppy to obedience class?*
Choose one: Yes No

Have you ever crate trained a dog?*
Choose one: Yes No

Are you willing to crate this dog if needed?*
Choose one: Yes No

Are you willing to pay the adoption fee which can range from $150-$350 to help defray the expenses associated with rescue and care? These fees help to ensure PAWS can continue our rescue efforts?*
Choose one: Yes No

Have you ever surrendered an animal to a shelter or rescue organization or given a pet away? If yes, please explain and list who/where animal was given up to.*

How many pets do you currently have?

Are ALL your other pets up to date on their vaccines?*
Choose one: Yes No Not applicable

Are ALL your current pets spayed or neutered?*
Choose one: Yes No Not applicable

If any of your pets are not spayed or neutered, why is that?

Current pet 1 name, age, species, and breed

Current pet 2 name, age, species, and breed

Current pet 3 name, age, species, and breed

Current pet 4 name, age, species, and breed

Current pet 5 name, age, species, and breed

Additional pets names, ages, species, and breeds

If any cats are listed above, are any of them overweight or on a special weight diet (if yes, please explain):

If you have in the last five years owned any other pets that are no longer with you, what was their name, age, species, and reason they are no longer part of your household?

What happened to previous pet(s) that is/are no longer in household?
Choose one: Died Euthanized Given away Ran Away Sold Stolen Surrendered

If euthanized, why? If died, how or from what?

What is the disposition of your previous animals?
Choose one: Leader Follower Friendly Aloof Outgoing Shy Demands attention Needs little attention Protective Quiet

How long were these animals part of your family?

Some rescues have pre-existing health conditions/problems that may require further care by the adopter (skin problems, cataracts, etc). Would you adopt an animal that has health problems?*
Choose one: Yes No

Are you aware of the yearly costs of maintaining a health pet?*
Choose one: Yes No

There are yearly vaccines, flea and heartworm prevention, dental care, healthy food, accessories, as well as many unforeseen items or circumstances such as accident or illness. Vet care can total in the hundreds or even thousands for extensive health issues. Are you prepared to meet these requirements?*
Choose one: Yes No

Veterinarian's Name and Phone Number. If not applicable, write n/a.*

Would you be willing to permit a home check by a volunteer?*
Choose one: Yes No

Would you be willing to stay in contact with the foster parent? *
Choose one: Yes No

Please list Name, Relation, and Phone # of at least two references

I attest that the information provided above is correct. I understand that this is only an application for adoption and does not constitute a contract or guarantee me to receive the pet applied for. PAWS has the right to refuse an adoption to any individual on any grounds. I give PAWS permission to verify the information provided on this sheet. Also, I agree to provide my Driver's License Information at time of adoption if I am approved. I also understand PAWS will not pay any vet bills. No refunds after 72 hours.*
Choose one: Yes No

Please electronically sign your application*

Please enter today's date.*