Pet Adoption Application Form

Adoption Application

Applicant Name *

First Name Last Name

Name of Pet You Wish to Adopt *

Please check all of the following reasons for adopting a pet that may apply. *

Watch Dog Breeding Hunting Family Pet Guard Dog Barn Cat Mouser Gift

Email Address *

Phone Number *

Area Code Phone Number

Work Number *

Area Code Phone Number

Employed by *

Age of Applicant *

Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

How long have you lived at this address? *

Driver's License State *

Do you own any pets? *

If Yes Please List Name, Breed, and Age? *

If you have current pets are they spayed or neutered? *

Yes No

If no, why not? *

List any pets you have had in the past 5 years, but no longer have? Name, Age, Gender, and if Cat/Dog? *

Why do you no longer have them? *

Please provide your veterinarian's name *

Please specify if vet records are not under your name

Veterinarian's phone number *

Area Code Phone Number

NOTE: Due to Federal Laws regarding the privacy act, you will need to contact your vet and give permission for PVHS to contact them regarding the status of your pets.

Do you own or rent your home? *

Own Rent

If you rent, please provide landlord's name *

If own type N/A & 0's in phone number line

Landlord's phone number *

Area Code Phone Number

Where do you currently live? *

House Apartment Condo Mobile Home

Type of Area *

City Suburb Rural

Do you have a fenced in yard? *

Yes No

Is it attatched to the house? *

Yes No

What type of of fencing? *

If you don't have a fence how will the dog be allowed to exercise/eliminate waste? *

Number of Adults in Household? *

Number of Children in the Household and their Age(s)? *

Who Will be the Primary Caretaker of the Pet? *

How many hours per day would the pet be alone? *

Where EXACTLY will the pet stay during the Day/Night? *

If you go on vacation or have an emergency who will care for the pet? *

Have you ever adopted from an Animal Shelter/Rescue Group before? *

Yes No

If Yes, Name of Group of Which You Adopted From? *

If you adopt a puppy or kitten, do you agree to have it spayed/neutered at your own expense in a few months? *

Yes No

If No, Why Not? *

NOTE: For a dog or puppy applications we would ask for 4-5 photos of your yard ONLY to be uploaded with this application. Suggested photos would be any fencing, gates, front yard, back yard, or any other areas in which the adopted might spend their time outside.

If the upload portion of this application isn't working correctly please feel free to email them to us at poteaupets95@gmail.com

*

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Terms and Conditions

I will never use the animal for research or fighting I will provide proper food, water, shelter,and companionship I will treat as a family companion and will not subject the animal to abuse or cruelty I will agree to spay/neuter the animal if not already done according to the Spay/Neuter Policy listed below. I will not use the animal for breeding purposes I will provide regular veterinary care. I will NOT tie the dog to a leash, rope, or chain as a means of confining the animal, except for emergency, short term duration. If for any reason I am unable to keep the animal, I will NEVER sell it or give it away--I will return it to PVHS

Spay/Neuter Policy:

Any animal that is too young to be spayed or neutered before adoption must be altered in a timely basis (timely is usually around 5 months of age for a female and 8 months for a male) with the cost being paid by the adopter. Any animal not spayed or neutered by adopter on a timely basis may be reclaimed by PVHS without refund to the adopter.

Date of Application *

Date

Best time to contact you? *

: Hour Minutes AM/PM Option

Until

until : Hour Minutes AM/PM Option

Signature of Applicant *

By submitting this form you accept all terms and conditions

Poteau Valley Humane Society