Prairie to Peaks Animal Assistance Foundation Pet Adoption Form
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
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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?
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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?
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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?
*
YES
NO
WHAT IS THE NAME & PHONE # OF YOUR VETERINARIAN?
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ARE THERE CHILDREN IN THE FAMILY?
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YES
NO
IF YES, WHAT ARE THEIR AGES?
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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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