Adoption Application

Please fill out this application completely and truthfully. Applications found to be incomplete will not be considered or reviewed. Applications found to be filled out falsely are grounds for permanent denial for adoption from our organization.

We process applications on a case by case basis. We understand things can happen or can be overlooked, all we ask is be honest in your answers and if we have concerns we will address them.

Every family and situation is different. There are pets that can be paired with most homes. We strive to make sure the pets in our program go to the best possible match to help set them and you up for success.

Perspective Pet Guardian*

First NameLast Name

Name of Pet You Wish to Adopt

Email Address*

example@example.com

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Are there others living in your home? If yes, please list names, ages, relationship to you, and occupation. Do not count children, list them in the next question.

Adults information that live in the home

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

What is your current employment situation?

Please list 3 references that do not live in your home, and at least 2 of those 3 that are NOT related to you. *

List name, phone number, relationship to you, & how long you’ve known them.

Have you or has anyone in your household ever been convicted of or charged with animal cruelty?

YesNoOther

Do you own any pets now?*

Current pet 1 - Please list Type, Name, Age, Gender, Breed, Weight

Current pet 2 - Please list Type, Name, Age, Gender, Breed, Weight

Current pet 3 - Please list Type, Name, Age, Gender, Breed, Weight

Current pet 4 - Please list Type, Name, Age, Gender, Breed, Weight

Current pet 5 - Please list Type, Name, Age, Gender, Breed, Weight

If no current pets, please tell us a bit about your previous experience with animals & pets owned - If you have more pets than 5, please list them here.

Do you understand there could be disagreements between your current and new pets, including resource guarding, fighting, acting out, destructive behaviors, etc?

How do you plan on solving initial pet disagreements and how much time are you willing to give the pets to find their balance?

Do you currently have a regular veterinarian you use?*

Please share the clinic name, veterinarians name, and their contact information. Please call them and give them consent to speak with us/release information. Please specify whose name the animals are under at the vet if different from applicants.

If you go to mobile or pop up clinics such as vetco or tractor supply, please understand we will ask for copies of records and you must be able to provide those.

Do you own or rent your home?*

OwnRentOther

If you rent, please provide your landlord's contact information & pet policy here:

You can email a copy of the pet policy to info@pawsitive-impact-animal-rescue.org also

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe your yard area.

Have you ever rehomed a pet ?*

YesNo

If the answer to the previous question is yes ,please explain.

What conditions or circumstances would cause you to rehome a pet in the future?

If you move houses, cities or countries in the future, what will happen to your pet(s)?

How would you describe your own and your family's energy level?

Are all of your family members in favor of adopting a rescue pet?

What qualities in a pet are the most important to you?

What type of personality do you want your pet to have?

Will the pet have access to the whole house? Specific rooms? Only outside?

Where will your new friend sleep at night?

Where will your new friend stay when nobody is home?

Why do you want to adopt a rescue pet?

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

Being that the pet to be adopted is a rescue animal, are you aware that it may have special challenges and behavioral problems?

What length of time will you allow your new pet to adjust to its new home?

Will you crate your pet(dog) or contain to a room (cats)? *

If you have to leave town, for an emergency or planned trip, 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, litterbox issues, furniture scratching etc?*

Do you understand that a pet can be an 18 year commitment possibly more, and can cost a reasonable amount of money per year to be cared for?

I understand that by completing this application, it doesn't guarantee the animal applied for will be adopted to me.
I understand that Pawsitive Impact does its best to only adopt out healthy animals or to fully disclose any medical issues prior to adoption.
I understand that I'm seeking to adopt a rescued pet that likely has an unknown medical, genetic, or behavioral history.
I understand that because of this, there is always a possibility for health or behavioral issues that could arise without any previous knowledge by PIAR.
I understand that any damages or fees incurred because of damages by the pet I'm adopting are solely my responsibility, should anything happen.
I understand that if I take my non fully vaccinated pet out in public, I risk it contracting a virus, disease, parasite, or other illness. Any of these could potentially cause the need for hospitalization or even the death of the pet. Any bills and fees incurred will be solely my responsibility.
I understand all medical care, prevention, food, training, or other supplies or necessities to keep my pet healthy and happy are my responsibility to provide and pay for.
I understand PIAR places no guarantee or warranty, either expressed or implied, on the behavior, health, and emotional state of the animal.
I understand and agree that PIAR is not liable for or responsible for any costs of care or medical once transfer of the pet is made. It is solely up to me to cover any and all expenses the pet may need.
I understand that my adoption donations are NON REFUNDABLE, and that those donations are immediately put towards the next pet in need as well as covering expenses for my pet while in the rescues care.
If for any reason I am unable to care for the pet I adopt, I will contact PIAR immediately and will allow them to reclaim the pet-my adoption donations will not be refunded.
If a licensed veterinarian deems euthanasia to be necessary, except in cases where a delay would cause extreme suffering to the animal, I will first contact PIAR before any decision is made.
I understand there could be an adjustment period of weeks months or in some cases a year, before my pet fully decompresses and feels at home.
I agree to be patient, understanding, and will do all I can to help the animal acclimate to my home and family.
I understand there are risks when adopting a rescued pet, I agree to not hold PIAR responsible for any issues that may arise.
I agree to keep the pet on prevention year round.
I understand that PIAR has many resources available to help me & my new pet better adjust to our new living situation & I will reach out if I'm struggling.
I understand that if I adopt an animal unaltered due to a veterinarians recommendation due to size/age or medical status, that I will have it altered by the age of 8months (unless deemed by a veterinarian to be a direct risk to the pets wellbeing). I will submit proof of spay/neuter to PIAR.
I understand that PIAR uses a professional transport company that is not affiliated with the organization & they have no control or say over designated stops, conditions on board ( though they will do their best to only work with gold star standard companies), delays, or delivery times.
I understand the pet I'm adopting will arrive with a packet of any medical care, vaccination records, and testing performed while in PIAR's care.
I understand I will recieve an email with other helpful or important documents in it.
I understand the pet I'm adopting will have age appropriate vaccinations, be microchipped(which I will need to register), and if age/size/ health appropriate, will be spayed/neutered.
I understand I will need to bring a slip leash or martingale collar (for dogs) or a crate (for cats ) for pickup and transfer of my new pet.
I understand that if PIAR receives reports of inadequate care for the pet I adopt, they will investigate & if need be, can & will confiscate the animal and cancel my rights to guardianship.

I hereby confirm that I have read and understood the above terms & I will assume full responsibility for the welfare of the pet from the date of adoption.
By clicking the submit button, I verify all of the above information is true and accurate.

Printed name of Potential Pet Guardian*

Signature*

Date*

Date

Pawsitive Impact Pet Adoption Application