Adoption Form - All4Paws Animal Rescue

Adoption Questionnaire

To begin the adoption process, please fill out this form completely. If you have problems using this form please send an e-mail to adopt@a4psc.org. We will contact you once the form is submitted and assist in finding your next four-legged family member!
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
Driver's License Number*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Birthday

MonthDayYear
Date
Type of Animal your looking to Adopt!*

Dog or PuppyCat or KittenNot Sure
Animal of interest
If unsure of a specific pet, are there any specific qualities that you are looking for in a pet?

CompanionWalking/Running PartnerSafetyESA AnimalCouch PotatoNon-shedding/HypoallergenicUnder 20 lbsGood with childrenGood with current dog(s)Good with current cat(s)Under 1 years old (I will make a commitment to train a puppy)
Best way to contact you?

Home PhoneCell PhoneEmail
Occupation
How did you hear about All4Paws?
Is this pet for you or someone else?*

MeSomeone Else
Please explain
Do you understand that adopting an animal could be a commitment for up to 18 years?*

YesNo
Type of residence you live in*

Single Family HomeCondo/TownhouseApartment
Do you rent or own?*

OwnRent
Please provide name and phone number for landlord/complex
Tell us about your home/family.
Please include names and ages of all household members and ages of any children that are regularly visiting the home.
Are all the members in your household in agreement with adopting this animal?

YesNo
Have you ever owned a dog or cat before?*

YesNo
Do you currently own pets?*

YesNo
Please list all animals in your home including sex, age, breed
Are your pets friendly with dogs?

YesNo
Are your pets friendly with cats?

YesNo
Are ALL of your pets spayed or neutered?*

YesNo
If No, please explain
Have you ever returned or rehomed an animal to a shelter?

YesNo
If yes, please explain
What happened to your previous pets? (if any)
Who is your current or former vet?
May we contact your Vet for a reference?*

YesNo
Veterinarian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are you planning on breeding the animal you adopt?

YesNo
Are you planning to declaw your cat/kitten?

YesNo
Are you willing, able and committed to take full responsibility for the medical care of this animal? (shots up to date, annual vet exam, emergency or chronic veterinary care if needed, medications if needed, special diet if required, etc...**

YesNo
Are you willing and committed to take full responsibility for training the animal? (housebreaking, leash training, chewing, barking, scratching, biting, etc)**

YesNo
What type of disciplinary action would you use to correct a pet's behavior?
Are you aware that certain breeds require regular grooming and may require additional costs for care?

YesNo
Are you willing to give your rescued animal adequate time to adjust to his/her new home? (this could take months)

YesNo
Do you have a fenced yard?

YesNo
May we visit your home?

YesNo
Where will the new pet spend the majority of time?*
When you are not home, where will the new pet stay?
Who will be the primary person responsible for the care of your new pet?*
Do you have a plan and what would it be in case something were to happen that would render you unable to care for your pets?*
If you had to move, what would happen with your pet?**
Is there anything else you would like for us to consider as we review your application?
The shelter will advise me of any known behavior or medical issues that the pet has shown but cannot guarantee the medical or behavior health of any adopted pet.*

By checking this box, I agree to the above statement.
I affirm that the information provided is true and correct to the best of my knowledge.*

By checking this box, I agree to the above statement.
I agree to receive periodic emails*

I agree to receive periodic email updates.
Should be Empty:

Adoption Questionnaire