PPAWS Pet Adoption - Information disclosure & Undertaking

Animal Adoption - Disclosure & Undertaking

Phnom Penh Animal Welfare Society (PPAWS)
To ensure that you are best equipped to be able to Adopt and care for life for one of PPAWS animals, we would be grateful if you could please provide us with an undertaking regarding your intentions and, some information to enable us to ensure we find you with the most suitable animal. Thank you!
Personal Information
Full name
Married/Partner or Single?

Married/PartnerSingle
If Married/Partner please provide their name/details
Residential address?
How long have you lived at this address?
If less than 6 months, where did you live before this and for how long?
Phone No

Area CodePhone Number
Best time to call you?
Email address
example@example.com
Nationality
Passport / Identity Card No
Personal Circumstances
Employment details or, if you do not work, please explain how will you provide for the animal in your care
At your residence who else lives there with you and what is their relationship to you?
How many children are in the home and what are their ages?
What type of home do you live in (House, Apartment, Farm, etc.)?
Do you have a garden or easy access to a garden/exercise area for the animal if appropriate?

YesNo
If you do, please explain where/size, etc.
Please describe your household

NoisyQuietActiveAverage
If your property is rented do you have the Landlords permission for a pet?

YesNo
If you share a property or, if you have a family, is everyone fully in agreement to Adopt an animal and if so, will they participate in its care?

YesNo
If "Yes' who will take primary responsibility for the animals wellbeing & care?
Does anyone in your household have any known allergies towards animals?

YesNo
How much time will you be able to spend with the animal on a daily basis?
If you work how long will the animal be left on its own during your working periods?
Are there any other pets in your household?

YesNo
If 'Yes': what types and ages?
Are the pets at your home fully vaccinated?

YesNo
Are they spayed/neutered?

YesNo
If not, please explain why
Can you provide a suitable bed, toys, collar & lead (if appropriate) for the animal?

YesNo
Your Experience with Animals
Please explain what experience you have had with animals, what types and over what period of time
In the past, have you ever given a pet you owned away?

YesNo
If "Yes" Please explain why.
Have you ever lost a pet to an accident?

YesNo
Please explain if 'Yes'
How do you discipline your animals, when would you do so and how
Adoption Animal Information
What type of animal do you want to adopt?

DogCat
Why are you interested to adopt an animal?
Please tell us the ideal animal you would like to Adopt
What is the preferred age, sex, etc.?
Are you willing to adopt an animal with special needs?

YesNo
If you answered 'Yes', what type of special needs would you consider (e.g. missing limbs, infirm, incontinent, partially sighted, etc.)?
Will you consider animals that have behavioral issues and need training?

YesNo
Are you willing to take responsibility for regular grooming, ear cleaning, etc.?

YesNo
Where would the animal spend its day?
Where will it spend the night?
If you were to adopt an animal from PPAWS will you allow us to periodically visit your home to assess how the animal is faring?

YesNo
If you adopted an animal and it required medical care, please confirm you are able and prepared to meet all costs incurred (at PPAWS or any other Clinic)

Confirm
Please confirm that if you were unable to reach anyone at PPAWS (for whatever reason), you would ensure the animal received proper Veterinary care at another Clinic if necessary

Confirm
Please confirm that should you Adopt an animal, it can never be given away to a third party if for any reason you cannot care for it, that you MUST contact PPAWS and discuss this with us first

Confirm
If you are an Expatriate and intend to return to your home Country in the future, please confirm that you will take the animal with you and will not try to get it re-homed or, give it away

Confirm
Do you fully understand and accept that any animal you Adopt is in your care and your responsibility and that you will need to sign a legal Fostering Agreement with PPAWS to confirm this

Confirm
Anything further you'd like us to know?
I confirm that all of the information I have given here is true and complete and that I have not misled or deliberately withheld any information that may impact on whether I would be able to Adopt a PPAWS animal. I similarly confirm that if I am able to Adopt an animal, I will also ensure that I provide it with a loving and stable home, that I will feed it according to any instructions I receive from PPAWS (and/or, according to typical best practice) and, that I will endeavour to provide the best quality of life I can for the animal for the duration of its life.
Signature

Clear
Name
Date

MonthDayYear
Date
Should be Empty:

Animal Adoption - Disclosure & Undertaking

Personal Information

Personal Circumstances

Your Experience with Animals

Adoption Animal Information