PPH Pet Adoption Application Form

Adoption Application, Contract and Waiver

Perspective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs?

Are your pets spayed and neutered?*

YesNo

Are your pets Up To Date on vaccines?*

YesNo

Are your pets microchipped?*

YesNo

Please provide your veterinarian's name and phone number:

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

What is your landlord's pet policy?*

If you rent, please provide your landlord's information here:*

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

If you answered "Yes" to the above question, please provide detail:

How many hours per day would the pet be alone?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 3 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I agree to PAWfect Pet Haven adoption process, will undergo a homecheck, and interview at the discretion of PAWfect Pet Haven.
By clicking the submit button, I understand PAWfect Pet Haven will check my references including veterinary and personal.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, the pet MUST come back to PAWfect Pet Haven. I agree to notify PAWfect Pet Haven by phone call and provide a 5 day period to allow us to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I understand that PAWfect Pet Haven will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to PAWfect Pet Haven.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*

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PLEASE NOTE