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GENERAL ADOPTION FORM
Home
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GENERAL ADOPTION FORM
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
Please enter any two digits
*
Example: 14
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