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Adoption Form
PAWS FOR LIFE USA
Adoption Form
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Today's Date
Month
Month
Day
Year
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Pet's name
Pet's ID
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Your Name
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Date of Birth
Month
Day
Year
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Age
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Driver's License/ID Number
Multi-line address
Country/Region
Address
City
Zip / Postal code
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Phone
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Email
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How long have you lived at the address above?
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Do you own or rent your home?
Own
Rent
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What kind of home do you live in?
Single-Family House
Duplex
Condominium
Mobile Home
Apartment
Dormitory
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If you lease, does your lease allow pets?
Yes
No
N/A
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If you lease/rent - is there a pet deposit?
Yes
No
N/A
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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?
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How many people live in your household?
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Do you have a roommate?
Yes
No
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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?
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Are you 18 or older?
Yes
No
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Do you live with your parents or other relatives?
Yes
No
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Are you or your spouse currently employed or retired?
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Are you or your spouse currently employed or retired?
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Who are you adopting this pet for? (Yourself, your child, other family member?)
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Will an adult be home during the day?
Yes
No
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What is the longest period of time the pet will be home alone on the average day?
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Who will be responsible for taking care of the pet?
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If adopting a dog or puppy, what procedures will you use for housebreaking?
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If adopting a dog or puppy, how will you handle scratching or destructive behavior?
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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?
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Please tell us about your pets owned in the last five years: Breed / Age / Spayed-Neutered / How Long Owned
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If you no longer have some or all of these animals, what happened to them?
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Do you presently have pet insurance?
Yes
No
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Are your pets micro chipped?
Yes
No
I don't have any pets yet
If they are micro chipped - with whom?
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Have you ever turned in an animal to an animal shelter?
Yes
No
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Where will pet stay during the day?
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Where will pet stay during the night?
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Do you have a fenced in yard?
Yes
No
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If so, how high is it? And what kind?
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If you do not have a fence, how will the dog get exercise and use the bathroom?
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For which of the following reasons would you give up your pet?
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Please explain other
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If you currently own a dog, is it on heartworm preventative?
Yes
No
I do not currently own a dog
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If yes, what brand?
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Do you currently have a Vet? If so, what is the name of your Veterinarian | Veterinarian Clinic?
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May we contact your Veterinarian?
Yes
No
Phone Number of Current Veterinarian
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Would you object to an authorized representative inspecting the current animals (if applicable) and premises where the adopted animal will be kept?
Yes
No
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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.
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Applicant Signature
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Guardian Signature (If under 18)
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Verification
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