PBAF ADOPTION REQUEST

PBAF ADOPTION REQUEST
Patricia Blanco Animal Foundation ADOPTION ENG

info@patriciablancofoundation.org
- Name*
  
  First NameLast Name
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email*
  example@example.com
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Style*
  
  Single Family HomeApartmentTownhouseFarmOther
- Occupation*
- Company Name*
- Work Phone #
  Please enter a valid phone number.Format: (000) 000-0000.
- Own or Rent*
  
  OWNRENT
- IF RENT* Do you have a permit of the landlord to bring animals? YES OR NO * .
  How many animals? EX: 2 * . For how long is your contract or lease
  EX: 1 yr*.
- Name and number of landlord*
- How many animals do you currently have?blanks*.
- How many hours will the dog or cat, be alone at home?*
  
  2-4 Hrs a day5-7 Hrs a day8-10 Hrs a day10+ Hrs a dayOther
- How many people live at home with you? blanks .
  What is their relationship with you? blank.
- Do you have any kids?
  blanks.
  How many kids?
  blank.
  What ages?
  blank
- Are all the family members agree to adopt?
- Are your kids used to being with animals?
- Does anyone in the family have a known allergy to dogs or cats?
- Describe household
  
  ActiveNoisyQuietAverage
- Have you had animals before?
  
  YesNo
- What kind of animal
- IF HAD ANIMALS BEFORE* Why your prior pets are not with you now?
- If they are disease, at what age they died?
- If they are disease, how did they died?
- Do you have animals now?blanks.
  What kind?blank . What breed?   blank.
  How many? .
  How old are your pets? .
- Are your pets used to be with other dogs or cats?
  
  YesNo
- Are your pets up to date on vaccines
  
  YesNoIf not, why?
- Are your pets spayed/neutered?
  
  YesNoIf not, why?
- Have you ever had a pet euthanized?
  
  YesNoIf so, why?
- If adopting a cat
- Have you ever declawed a cat?
  
  YesNo
- Are you planning to declaw a cat?
  
  YesNo
- If adopting a dog
- Have you ever cut the tail or ears to a dog?
  
  YesNo
- Are you planning to cut the tail or ears to a dog?
  
  YesNo
- Do you have a regular veterinarian?*
  
  YesNo
- Veterinarians' phone number
  Format: (000) 000-0000.
- Veterinarians' name
  
  First NameLast Name
- Clinic Address
  
  Street Address
  
  Clinic Name
  
  CityState / Province
  
  Postal / Zip Code
- What animal would you like to adopt?*
  
  CatDog
- How many?*
- *
  
  PuppyAdultBreed
- How big can be when full growth?*
  
  SmallMedLarge
- Where you'll keep the keep the pet during the day?*
  
  InsideOutsideCage
- Number of hours (average) dog will spent alone?*
- Where you'll keep the keep the pet during the night?*
  
  InsideOutsideCage
- Can you walk a dog at least three (3) times a day?*
- Will the pet have access to the entire house?*
- You understand that if you are adopting a pet it may need house training? Yes No* Do you agree to provide it, if need it? blank* .
- Who has the financial responsibility of this pet?*
- Do you agree to provide regular health care by a licensed veterinarian?*
  
  YesNoOther
- Do you agree to call PBAF if you can no longer keep this pet?*
  
  YesNo
- Will you allow a PBAF representative to visit you, with a prior appointment to follow up the adoption?
  
  YesNoOther
- Please provide us with three personal preference who are familiar with you, your family and your current pets (if any)
- Name*
  
  First NameLast Name
- Email*
  example@example.com
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- RELATIONSHIP*
- Name*
  
  First NameLast Name
- Email*
  example@example.com
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- RELATIONSHIP*
- Name*
  
  First NameLast Name
- Email*
  example@example.com
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- RELATIONSHIP*
- By signing this agreement, you are bound to the rules of our organization:
  
  |*| If you can not keep the pet you agree to contact us to give it back to us.
  
  |*| You understand that adoptions to third parties are not allowed.
  
  |*| By adopting a dog or cat from PBAF you are committed to look after the welfare and safety of this pet.
  
  |*| You will not declaw, cut ears or tail to this pet by any means.
  
  |*| You agree to provide love, safe shelter, good space, food, water (all the time), and veterinary care to this pet.
  
  Note: Our animals are part of the family, we do not give animals in adoption to live in the yard, chained or caged.
  
  The body temperature of the dog is 3 degrees above the human body, reason why, leaving a dog outside with temperatures above 85 F can cause a heatstroke.
  
  Rember our pets (specially the short hair ones) are very susceptible to cold weather and it can cause skin, breathing and other health conditions.
  
  According to Florida's Animal Protection Law, since March 2011, it's PROHIBITED to keep an animal chained, unless is is for a walk or event, and if so, it has to be under direct supervision.
  ESPAÑOL: Al firmar este acuerdo, está sujeto a las reglas de nuestra organización:
  | * | Si no puede quedarse con la mascota, acepta contactarnos para devolvérnosla.
  
  | * | Entiendes que no se permiten adopciones a terceros.
  
  | * | Al adoptar un perro o un gato de PBAF, usted se compromete a velar por el bienestar y la seguridad de esta mascota.
  
  | * | No le quitará las uñas, le cortará las orejas o la cola a esta mascota de ninguna manera.
  
  | * | Acepta proporcionar amor, refugio seguro, buen espacio, comida, agua (todo el tiempo) y atención veterinaria a esta mascota.
  
  Nota: Nuestros animales son parte de la familia, no damos animales en adopción para que vivan en el patio, encadenados o enjaulados.
  
  La temperatura corporal del perro está 3 grados por encima del cuerpo humano, por lo que dejar a un perro afuera con temperaturas superiores a los 85 F puede provocar un golpe de calor.
  
  Recuerde que nuestras mascotas (especialmente las de pelo corto) son muy susceptibles al clima frío y puede causar problemas en la piel, la respiración y otros problemas de salud.
  
  De acuerdo con la Ley de Protección Animal de Florida, desde marzo de 2011, está PROHIBIDO mantener a un animal encadenado, a menos que sea para una caminata o un evento, y si es así, tiene que estar bajo supervisión directa.
- Adopter (print name)*
- Adopter (signature)*
- date*
  
  MonthDayYear
  Date
- Upload of Valid ID
  
  Cancelof
- Application reviewed by
- PBAF charge an adoption fee which will help to cover some veterinary expenses and travel expenses if need it.
  
  Your contribution to us is tax deductible since we are an exempt organization as described in section 501 (c) 3 of the USA Internal Revenue Service Code. EIN: 46-278667
  
  Dominican Republic RCN: 4-30-21575-9
  
  ESPAÑOL:
  
  PBAF cobra una tarifa de adopción que ayudará a cubrir algunos gastos veterinarios y gastos de viaje si es necesario.
  
  Su contribución a nosotros es deducible de impuestos ya que somos una organización exenta como se describe en la sección 501 (c) 3 del Código del Servicio de Impuestos Internos de EE. UU. EIN: 46-278667
  
  República Dominicana RCN: 4-30-21575-9
- Approved by Officer of PBAF
- Should be Empty:

PBAF ADOPTION REQUEST

If adopting a cat

If adopting a dog

Please provide us with three personal preference who are familiar with you, your family and your current pets (if any)