PAWS FOR LIFE USA

Adoption Form

Today's Date

Month

Day

Year

Pet's name

Pet's ID

Your Name

Date of Birth

Month

Day

Year

Age

Driver's License/ID Number

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Email

How long have you lived at the address above?

Do you own or rent your home?

Own

Rent

What kind of home do you live in?

If you lease, does your lease allow pets?

Yes

No

N/A

If you lease/rent - is there a pet deposit?

Yes

No

N/A

If there is a pet deposit required, has it already been paid?

Yes

No

N/A

If there is a pet deposit required, how much is it?

If you lease, what is the name of your Complex and or Landlord?

How many people live in your household?

Do you have a roommate?

Yes

No

Do all members of the household know you are planning to adopt a pet?

Yes

No

What are the ages of any Children and/or Grandchildren who reside in or visit your household?

Are you 18 or older?

Yes

No

Do you live with your parents or other relatives?

Yes

No

Are you or your spouse currently employed or retired?

Who are you adopting this pet for? (Yourself, your child, other family member?)

Will an adult be home during the day?

Yes

No

What is the longest period of time the pet will 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?

If adopting a dog or puppy, how will you handle scratching or destructive behavior?

If adopting a dog or puppy, what plans do you have for basic obedience training?

How many cats and/or dogs have you owned in the past five years?

Please tell us about your pets owned in the last five years: Breed / Age / Spayed-Neutered / How Long Owned

If you no longer have some or all of these animals, what happened to them?

Do you presently have pet insurance?

Yes

No

Are your pets micro chipped?

Yes

No

I don't have any pets yet

If they are micro chipped - with whom?

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?

Please explain other

If you currently own a dog, is it on heartworm preventative?

Yes

No

I do not currently own a dog

If yes, what brand?

Do you currently have a Vet? If so, what is the name of your Veterinarian | Veterinarian Clinic?

May we contact your Veterinarian?

Yes

No

Phone Number of Current Veterinarian

Would you object to an authorized representative inspecting the current animals (if applicable) and premises where the adopted animal will be kept?

Yes

No

Applicant Acknowledgement: By checking this box you acknowledge all information provided is true and accurate.

All information provided is true to the best of my knowledge.

Applicant Signature

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Guardian Signature (If under 18)

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Verification

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