Preadoption Application

Paws and Effect Medical and Maternal Rescue Preadoption Application
Paws and Effect is a non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Paws and Effect is completely funded through fundraising efforts and public donations. All of our pets are cared for within the director's home and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.
This questionnaire is designed to help Paws and Effect and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. The answers to this questionnaire do not immediately qualify or disqualify any potential adoption, but Paws and Effect reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions
Applicant Information
Name of the dog you are interested in:*
Your full name:*
Your age:*
Street Address:*
City, State, Zip*
Cell phone:*

Area CodePhone Number
Work Phone:

Area CodePhone Number
Home Phone:

Area CodePhone Number
E-mail:*
Employer:*
Character reference and phone number:*
Household Information
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:
Does your landlord allow dogs?*

YesNo
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Do you have a fully fenced yard?*

YesNo
Height and type of fence
Do you have any of the following?

Underground fenceKennelDog Run
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?
Have your children been around animals before?

YesNo
Tell us about yourself! What do you and the other housemembers like to do with your pets? (Hang out and watch TV, hiking, swimming, going out to socialize with other dogs, etc)*
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
Current/Previous Pet Information
List any pets you own or have owned in the past five years, what type of animal they are, and their current ages, or age they were last you had them.*
Where are these animals now?*
Are these pets spayed/neutered?*
Have you rescued/adopted a pet before?*

YesNo
If yes, what group?
Have you ever given up a pet?*

YesNo
If yes, what were the circumstances?*
Please provide the name and phone number of your current and/or previous veterinarian or clinic:*
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Do you have any particular criteria that need to be met in bein paired with your new pet? (I.e. already potty trained, obedience trained, doesn't bark, good with kids, size or maximum weight, breed preferences)*
Have you had a puppy before?*

YesNoYes, but it has been a long timeI am interested in adopting an adult, and this does not apply
Have you ever house-broken a dog before?*

YesNo
Are you aware of and willing to utilize crate training methods?*

YesNo
How many hours each day will your new pet be home alone?*
Where will your new pet sleep at night?*
How will you supervise the dog's outdoor activity?*
Where will your new dog stay when nobody is home?*
Do you plan to take an obedience class with your dog?*

YesNoNot sure
Are you willing to work through your new pet's issues, if any?*

YesNo
Do you understand that it takes a minimum of two weeks for a dog to adjust to a new home environment?*

YesNo
How will you handle destructive puppy behaviors like chewing?*
Do you understand that a dog is an 18 year commitment which should not be abandoned because of moving or changes to family dynamic (i.e. having a child or getting a divorce)?*

YesNo
Do you understand that outside of preventative care, that additional medical care may be necessary, carrying additional cost? Are you willing to incur emergency medical expenses for the wellbeing of your dog?*

YesNo
Do you understand that, in the event a dog must be rehomed, that they may ONLY be returned to Paws and Effect and that a $250 intake fee will be assessed? Do you understand Paws and Effect has the right to take legal action for any dog found to have been otherwise rehomed by the adopter?*
To acknowledge, type your full name
What circumstances would lead you to give up your new dog?*
Do you have any additional questions I can answer for you about the dog or about the adoption process? (Optional)
How did you find out about Paws and Effect Medical and Maternal Rescue?*

Adoptapet.comPetfinder.comFacebookFriend/Family MemberOther websiteOther
By submitting this form, I declare that the information provided above is true, complete and correct. I also understand that any willful dishonesty may render for refusal of this application. I also understand that these applications will be reviewed by the adoption counselors to ensure the best match for each dog, and that my application may be declined.

Paws and Effect will do their best to reply to each applicant, but in instances where several applications come in for a pet, may not be able to do so.
Should be Empty:

Paws and Effect Medical and Maternal Rescue Preadoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information