Pitiful Pups Adoption Application

Pitiful Pups Dog Adoption Application
Thank you for your interest in a Pitiful Pup! All of our available animals are listed on our facebook page. We require a NON-REFUNDABLE adoption donation. This donation is required ONLY IF YOUR APPLICATION IS APPROVED.

Adoption donations vary by pet since we assist so many special needs dogs.

What your adoption donation covers:

Your new pets’ spay or neuter

Heartworm test

ALL vaccines, including Rabies (Note: we do not administer Leptospirosis or Bordetella)

To adopt from us, please fill out our online application below. You can also print and mail your application and contract to Pitiful Pups, PO Box 1212, Bixby, OK 74008.
Applicant Information

(Must fill out ALL fields, if ALL fields are not filled out, it will not submit, if it's not applicable, just put n/a) Please take your time filling out the application.
Name:*
Street address:*
City, State, Zip:*
Phone:*

Area CodePhone Number
E-mail:*
Name of a personal reference. Not your vet or a relative. *
Phone of reference:*

Area CodePhone Number
Name of a personal reference. Not your vet or a relative. *
Phone of reference:*

Area CodePhone Number
Household Information
My dwelling is a:*

HouseCondoApartmentMobile HomeOther
Do you own or rent your dwelling?*

OwnRent
If renting, please provide the name and phone number of your landlord. *
How long have you lived at your current address? *
Do you have a fenced yard?*

YesNo
What type of fence do you have? *
Please answer correctly as we may ask for a video of your yard
If you chose "other" as your type of fence, please explain:
What type of fence do you have?
Number of adults in the household:*
Age(s) of adults in the household:*
Number of children in the household:*
Age(s) of children in the household:*
Current/Previous Pet Information
Have you ever surrendered a pet to a shelter or a pound? Have you ever given a pet away? If yes, please describe the circumstances. *
How many cats do you own?*
How many dogs do you own?*
Please tell us why, and a little about why you think now is a good time for you to adopt. We try very hard to match pets with the right people and people with the right pets. Understanding your circumstances makes it easier for us to help first time pet adopters along with seasoned pet adopters be successful pet owners.*
Please provide us with your veterinarian's information along with phone number as well as any name(s) your pet might be under at the clinic. *
New Pet Information
What dog are you applying to adopt?*
Why do you wish to adopt this dog?*

Companion for meCompanion for my childrenA giftA watch dogOther
Have you adopted from Pitiful Pups before?*

YesNo
Average time the pet will be left alone:*

0-2 hours2-4 hours4-6 hours6-8 hoursMore than 8 hours
When left alone, I will keep the pet:*

Loose in the garageLoose in the houseLoose in the yardCrated in the yardCrated in the houseTied or staked in the yardOther
At night, the pet will sleep:*

Loose in the garageLoose in the houseLoose in the yardCrated in the yardCrated in the houseTied or staked in the yardOther
Your full name:*
Only fill out if you are adopting a puppy from Pitiful Pups, Inc.

I, First Name Last Name , understand that in adopting this puppy of of age, I agree to spay/neuter him/her by the time he/she is 5 months of age at a vet of Pitiful Pups, Inc. choice (if you choose to use your own vet, or a different vet than what Pitiful Pups, Inc. recommends, you will be responsible for the bill). I will provide Pitiful Pups, Inc. with proof of spay/neuter immediately following the procedure. I understand that Pitiful Pups, Inc., reserves the right to remove the puppy from my care if spay/neuter is not completed by 5 months of age. Signature Date
Date/Time:*
Your type your full name*
Signature (please make signature readable)*

Clear
Please verify that you are human*
Should be Empty:

Pitiful Pups Dog Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information