PAWS Pet Adoption Application 2021

Name of the Pet you wish to adopt

Type of Pet

Cat Dog

Full name

Address

Occupation

How long living at this address?

Daytime Phone

Evening Phone

Best time to call

Email address

example@example.com

How many adults live in house and relationship to you?

How many children and ages?

Please describe your household

Active Noisy Quiet

What type of home do you live in?

Single Family Townhome/condo Apartment Farm Other

Do you:

Own Rent

If you rent, please provide the rules regarding pets and your landlord's name and contact information:

Does anyone in the family have a known allergy to cats/dogs?

Yes No

Is everyone in agreement with the decision to adopt a dog/cat?

Yes No

What other pets do you have in your household? (specify type and number)

Are these pets up to date on vaccines?

Yes No

If no, why?

Are these pets spayed/neutered?

Yes No

If not, why?

Have you ever surrendered/rehomed a pet?

Yes No

If yes, why?

Have you ever had a pet euthanized?

Yes No

If yes, why?

Have you ever lost a pet to an accident?

Yes No

How?

How do you discipline your pets and why?

Do you have a regular veterinarian?

Yes No

Veterinarian's name

Clinic Name

Clinic Address

Clinic Phone

Providing PAWS with this information you are allowing PAWS to call your vet. Please call your vet and ask them to authorize the release of information to PAWS

Where will the dog/cat spend the day? (describe)

Where will the dog/cat spend the night? (describe)

Number of hours (average) dog/cat will spend alone?

Who will have primary responsibility for this dog's/cat's daily care?

Who will have financial responsibility for the dog/cat?

Do you agree to provide regular health care provided by a licensed veterinarian?

Yes No

Do you agree to contact PAWS if you can no longer keep this cat/dog?

Yes No

Are you willing to let a representative of PAWS visit your home by appointment?

Yes No

Please list someone who is familiar with both you and your pets.

Name

Address

Phone

Relationship (relative, neighbor, friend, etc.)

All the information I have given is true and complete. This dog/cat will reside in my home as a pet. I will provide it with quality dog/cat food, plenty of. fresh water, indoor shelter, affection, annual vaccinations, and medical treatment under the supervision of a licensed Veterinarian. If I cannot, I will contact Mason County PAWS.

Signature

Clear

Date