Prairie to Peaks Animal Assistance Foundation Pet Adoption Form
Method of Response and Time Frame
Cynthia Misner will call you within 72 hours of submitting this document via 701 240 3898. Please answer your phone. We verify with your landlord if applicable and your vet clinic. Please give the correct vet clinic where you have your account and whose name the account is under to simplify the verification process.If you don’t have an account with a local vet clinic, please set one up.
YOUR NAME
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First Name
Last Name
Email
*
example@example.com
NAME OF PET THAT YOU ARE APPLYING FOR
*
ARE YOU OVER 18 YEARS OF AGE?
*
YES
NO
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOW LONG AT THIS ADDRESS?
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DAYTIME PHONE
*
-
Area Code
Phone Number
EVENING PHONE
*
-
Area Code
Phone Number
OWN YOUR HOME?
*
RENT? (if yes, you must have landlord approval)
*
What is your landlord’s phone number, email address and physical address?
*
WHERE WILL YOUR ADOPTED PET SPEND THE DAY?
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WHERE WILL YOUR ADOPTED PET SPEND THE NIGHT?
*
HAVE YOU OWNED PETS IN THE PAST 3 YEARS?
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YES
NO
IF YES, WHAT HAPPENED TO THEM?
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WHAT ANIMALS DO YOU OWN NOW?
*
ARE THEY SPAYED OR NEUTERED?
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YES
NO
IF NO, PLEASE EXPLAIN:
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IF YOU OWN OTHER DOGS OR CATS ARE THEY CURRENT ON VACCINATIONS?
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YES
NO
WHAT IS THE NAME & PHONE # OF YOUR VETERINARIAN?
*
ARE THERE CHILDREN IN THE FAMILY?
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YES
NO
IF YES, WHAT ARE THEIR AGES?
*
ARE YOU FINANCIALLY PREPARED TO PROVIDE THE NECESSARY CARE FOR YOUR PET: INCLUDING PROPER FOOD, VACCINATIONS, PARASITE CONTROL (FLEAS, TICKS, WORMS, ETC.) ADEQUATE SHELTER, AND VETERINARY CARE FOR YEARLY CHECK-UPS AND MEDICAL EMERGENCIES?
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YES
NO
HAVE YOU EVER PLACED A PET IN AN ANIMAL SHELTER?
*
YES
NO
IF YES, WHAT WAS THE REASON?
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BY TYPING MY FULL NAME BELOW, I AFFIRM THAT ALL INFORMATION ABOVE IS TRUE. I REALIZE THAT THIS IS A LIFETIME COMMITMENT AND WILL ENDEAVOR TO GIVE THIS PET A HAPPY AND HEALTHY HOME. IF THERE ARE PROBLEMS WITH THIS PET OR I MUST GIVE HIM UP I WILL CONTACT PRAIRIE TO PEAKS ANIMAL ASSISTANCE FOUNDATION .
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TYPE FULL NAME HERE
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