PAWS ANIMAL RESCUE

DOG ADOPTION APPLICATION

Contact Information

Name:       

Address:       

City:                                                            State:                      Zip Code:       

Home Phone:                     Work Phone:                      Cell Phone:       

Best Time to Call:                                      Email Address:       

Occupation:       

Spouse's Name (if applicable):       

Spouse's Occupation (if applicable):       

Personal References

Reference 1:

Name:       

Address:                                                                 City:                        State:       

Phone:                                                        Email Address:       

Relationship:       

Reference 2:

Name:       

Address:                                                                 City:                        State:       

Phone:                                                        Email Address:       

Relationship:       

Application Questions:

1.   Why do you want a dog?       

2.   Description of Residence:   House    Apartment    Mobile Home    Condo                                                        Other:       

3.   Do you:   Rent               Property Owner Name:       

                                                Phone:       

                      Own              Length of time at current residence:       

4.   Do you have a fenced yard?    Yes    No      Type:   Wood Privacy     Chain Link

                                                                                                 Iron    Other:       

      Height of Fence:       

5.   Number of people in household:  Adults:           Children:       

6.   Ages of Children:       

7.   Are you willing to let a representative of Paws Animal Rescue, Inc. visit your home by             appointment?   Yes    No, if no why not?       

8.   Who will care for the dog?       

9.   Who will support this dog financially?  Myself   Spouse    Parents    Family    Friend

Fenced Yard	Tied Outside	Loose Outside
Kennel/Run	Garage	Patio/Balcony
Inside Home	Other:

10. Where will you keep this dog?

                                                                

Fenced Yard	Tied Outside	Loose Outside
Kennel/Run	Garage	Patio/Balcony
Inside Home	Other:

11. Where will you keep this dog at    night? 

                    

Fenced Yard	Tied Outside	Loose Outside
Kennel/Run	Garage	Patio/Balcony
Inside Home	Other:

12. Where will you keep this dog        when you are not at home?

13. How many hours, on average, will this dog spend alone?       

14. How many hours, on average, will this dog spend outside by itself?       

15. If you do not have a fence, how will you handle this dog's exercise and toilet duties?

16. Please list all dogs and cats currently living at your address and any pets you have owned in the last three years:

Species	Breed	Name	Age	Sex	Altered	Vaccinated
				M     F	Y    N	Y   N
				M     F	Y    N	Y   N
				M     F	Y    N	Y   N
				M     F	Y    N	Y   N

17. What happened to pets that are no longer with you?     

18. Will you obedience train your dog?    Yes     No

19. Please describe your training plans:       

20. Please describe the extent of care that you are willing to provide should your dog have            special medical needs now or later in life:       

21. Will you have your dog vaccinated annually by a veterinarian?     Yes     No

      Comments:       

22. Please describe what you know about the causes and prevention of Heartworms:       

23. Will you maintain your dog on heartworm preventative?     Yes     No

24. Do you currently have a veterinarian?     Yes     No

      Name:       

      Address:       

      City:                                                                  State:                      Zip Code:       

      Phone:       

25. Please indicate which dog you are interested in adopting:       

By completing this form, you will assist us in establishing that you and your family are ready for the responsibilities of pet ownership.  It will also aid us in determining which pet may best suit you and your lifestyle.

No animal will be adopted to prospective owners who mislead or fail to provide accurate information on the adoption application and/or the adoption contract.  Paws reserve the right to refuse adoption to anyone.

I certify that the above information is true and that false information may result in nullifying this adoption.

Enter your name and date:

Name:                                                                                          Date: