Pawsitive Change Matters Most
Adoption Application
Full Name of Primary Applicant
First Name
Last Name
Full Name of Co-Applicant (If-Applicable)
First Name
Last Name
Relationship of Co-Applicant
Spouse
Child
Roommate
Other
Primary Applicant Email
example@example.com
Secondary Email (if applicable)
example@example.com
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Which specific pets are you interested in? If not sure, type N/A ?
Pet's Name
Our application process is not first come, first serve. We really take the time to get to know our animals and applicants to match them together perfectly. Many times, our adopters find themselves falling in love and adopting a different pet that may be a better fit for their family. If a different pet may be a better fit, would you be interested in hearing about him/her?
Yes
No
Summarize your experience with animals:
Do you currently own any pets?
*
Dogs
Cats
None
Other
# Dogs
# Cats
# Other animals indoors
Please list the types, breeds, and ages of your animals. (type N/A if none)
*
Why do you want to adopt?
*
Companionship
Protection
To add a new family member
To save a life
Other
Is there anyone in your home with pet allergies?
Yes
No
If yes, please summarize the type of pet allergies and who in the household has the allergies.
Have you ever adopted an animal from a rescue or shelter?
*
Yes
No
Have you ever surrendered an animal to a rescue or shelter?
*
Yes
No
Have you ever re-homed an animal for any reason?
*
Yes
No
Have you ever had a serious behavior problem with a pet? If so - please describe how you handled it.
How committed will you be to this pet?
*
High
Medium
Low
Are you willing to work with your new dog the same as your own, to overcome behavioral problems, house breaking, or trust issues?
What type of house training methods will you use?
Do you have any experience crate training a dog?
Yes
No
How much time do you realistically have each day to exercise, play with or train your pet?
*
Less than 1 hour
1 to 3 hours
4 to 6 hours
All day
Approximately how many weeks a year are you away form your home?
*
0 to 2 weeks
3 to 4 weeks
5 to 6 weeks
7+ weeks
How will you encourage/reinforce appropriate behavior?
Treats
Praise
Toys
Love
Trip to the park
How will you prevent/manage inappropriate behavior?
Timeout
Spank
Yell
Ignore
Redirect
Correct
No treats
Other
Will your pet ever be left outside unattended when you're not home?
*
Sometimes
Always
Only during nice weather
Never
How much do you estimate it will cost to own this animal?
$0 to $500
$500 to $2500
$2500+
I don't know
What will you do with your animal if you move?
*
Rehome
Take to a shelter
Take with you to your new home
Return to foster
What reasons might cause you to return this pet?
*
Moving and can't keep
I started a new relationship and my partner does not like my pet.
I had a baby or adopted a child.
My work schedule changed.
Other circumstances changed.
Someone in home is allergic.
Illness or other personal emergency
Personal illness or emergency
Excessive shedding
Loss of employment
Pet isn't housebroken
Pet becomes aggressive.
Other
None
What age most appeals to you?
Baby
Young
Adult
Senior
What size most appeals to you?
Small
Medium
Large
Extra large
Type of coat?
Short-haired
Long-haired
No preference
What activity level most appeals to you?
High
Medium
Low
How important is it for this animal to adapt well to new surroundings?
Very important
Somewhat important
Not very important
How important is it that this animal be affectionate with you, your family, and/or your friends?
Very important
Kind of important
Not important at all
What level of shedding are you willing to consider?
Shedding doesn't bother me so any amount is fine!
Some shedding is ok.
I do not want an animal that sheds.
Mark important musts for this animal.
*
Do well with other dogs.
Do well with cats.
Do well with young children.
Do well with older children.
Comfortable with strangers
House trained
Minimal health issues
Obedient and responds to commands or prompts
Minimal howling or barking
Playful and active
Lazy and sedentary
Loves the outdoors
Loves water
Do you own or rent?
*
Own
Rent
Do you plan to move within the next year?
Yes
No
Unsure
Are there children in the home?
*
Yes
No
Who will be the primary caretaker for the animal?
*
Myself
Spouse
Other
Not sure yet
Please list the names and ages of all persons living in your home.
*
Is everyone in the household in agreement with adopting a pet?
*
Yes
No
Please mark any of these your home has.
*
Fenced in yard - Chainlink 4 feet or less high
Fenced in yard - Chainlink 4+ feet high
Fenced in yard - 6ft privacy fence
Stairs
Pool
Where will your new pet be kept when you're not home?
*
Outside
Crated
Closed off room or area inside the home
Animal Daycare
Free roaming the home indoors
Do you live in an area or community with breed restrictions or other animal regulations?
*
Yes
No
Do you foster or volunteer for any other organizations? If so, please tell us about your volunteer experience.
References
Reference #1 Full Name
*
First Name
Last Name
Reference #1 Phone Number
-
Area Code
Phone Number
Reference #1 Type
Friend
Coworker or former coworker
Family member
Other
Reference #1 Email
example@example.com
Reference #2 Full Name
*
First Name
Last Name
Reference #2 Phone
-
Area Code
Phone Number
Reference #2 Email
example@example.com
Reference #2 Type
Friend
Coworker or former coworker
Family member
Other
Reference #3 Full Name
*
First Name
Last Name
Reference #3 Email
example@example.com
Reference #3 Phone Number
-
Area Code
Phone Number
Reference #3 Type
Friend
Coworker or former coworker
Family member
Other
Vet Reference
Vet Name
*
Vet Email
example@example.com
Vet Phone Number
-
Area Code
Phone Number
How long have you been using this vet? If less than 2 years, please indicate your previous vet.
Are all of your animals altered?
*
Yes
No
Some but not all
If not all of your animals are altered, please explain why.
Are all of your animals up to date on vaccinations?
*
Yes
No
Some but not all
If not all of your animals are up to date on vaccinations, please explain why.
Landlord Reference
Landlord Name
First Name
Last Name
Landlord Phone Number
-
Area Code
Phone Number
Landlord Email Address
example@example.com
Acknowledgement
Pawsitive Change Matters Most reserves the right to refuse any application. We are unable to process an incomplete application. By initialing throughout, you are hearby agreeing to these contractual terms and conditions.
Initial Here
I AGREE that by submitting this application, with or without a signature, will certify that all the information on this application is true and complete and that no one in the household where the pet will reside has ever been convicted of animal abuse:
Initial Here
I AGREE to care for this pet humanely (including adequate food, shelter, water and veterinary care) and to license this dog in accordance with the laws of the area in which I reside.
Initial Here
It is understood that a representative of the rescue group may examine and make inquiry about the pet I am applying to adopt at any time. If not satisfied with the condition of the pet or the conditions in which it is being kept, that the pet can be removed and placed in a different home.
Initial Here
Signature
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