PAWSITIVELY RESCUED ADOPTION APPLICATION
PAWSITIVELY RESCUED keeps your information PRIVATE.
THANK YOU FOR YOUR INTEREST IN ADOPTING FROM PAWSITIVELY RESCUED!
Please answer all the questions completely and accurately as you can, as the information you provide will help us match you with your PERFECT FURRY FUREVER FRIEND.
This application is for:
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Dog
Puppy
Name of dog/puppy you are interested in:
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Applicant Information:
First Name:
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Last Name:
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Middle Initial:
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What year were you born?:
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Enter the year you were born
Drivers license number?
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State Issued:
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Full Name of Spouse/Partner, including their middle Initial. If none, enter NONE:
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Applicant's E-mail:
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Street Address:
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City:
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State:
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Zip:
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Home Phone:
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Area Code
Phone Number
Cell Phone:
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Area Code
Phone Number
Occupation:
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Work Schedule:
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Spouse/Partner Occupation:
Spouse/Partner Work Schedule:
Names of all persons living in your household, their relationship to you and their ages:
Does EVERYONE in your family want to adopt?
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Yes
No
Type of Dwelling:
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Single Family Home
Apartment
Condo / Townhouse
If you live in a condo, townhouse, apartment or are part of an HOA, what are the association's rules about pets?
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Do you own or Rent?:
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Own
Rent
If not a home owner, do you have the landlord's permission to have a pet?
Yes
No
Landlord's Name:
Landlord's Phone #:
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Area Code
Phone Number
Association name :
Association's Phone #:
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Area Code
Phone Number
All adoptions will require an in home adoption. Are you willing to allow us to come to your home to do the adoption?
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Yes
No
Your Companion Animals
Do you have the financial means to spend hundreds or even a few thousands of dollars on veterinary care for your pet should the need arise?
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Yes
No
Do you presently have a dog or cat?
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Yes
No
Are your current pets friendly with dogs?
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Yes
No
Have you previously had a dog or cat?
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Yes
No
Current Dog(s) Cats(s)
If you have no other pets, please indicate NONE
NAME & Breed of Pet (1):
Age:
Spayed/Neutered?
Yes
No
Current on vaccines and heartworm prevention?
Yes
No
If NO, Please Explain:
Pet History
Gave away
Sold
Lost
Took to pound (Explain)
Other (Explain)
Still have pet
Explain:
NAME AND Breed of Pet (2)
Age:
Spayed/Neutered?
Yes
No
Current on vaccines and heartworm prevention?
Yes
No
If NO, Please Explain:
Pet History
Gave away
Sold
Lost
Took to pound (Explain)
Other (Explain)
Still have pet
Explain:
Additional Pets:
Have any of your dogs/cats ever had puppies/kittens?
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Yes
No
If yes, you bred for (Check all that apply.):
Fun
Profit
Show
Other (Explain)
Explain:
Has any member of your family ever experienced animal-related allergies?
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Yes
No
Have you ever trained a dog in obedience classes?
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Yes
No
Other Pets
Do you have other pets?
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Yes
No
How Many?
NAMES OF EACH & Species:
Where Kept?
How long have you had pet(s):
If cat, de-clawed?
Yes
No
Veterinarian
Name of Vet:
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Name of the person who is on the vet records :
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Phone Number
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Area Code
Phone Number
Your New Dog
Your primary reason for adopting:
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Compainion for me
Companion for child
Companion for dog
Gift
Watch dog
Are you willing, able and committed to take full responsibility for the medical care of this dog? (Keeping shots up to date, annual vet exam, emergency or chronic veterinary care if needed, medications, including heartworm preventative, special diet if required, etc.
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Yes
No
Who would be responsible for pet's care?
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Where will your pet sleep?
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Indoors
Outdoors
Where?
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Hours per day pet will be left alone?
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Where would the pet be left when he/she is alone or when you are away from your home?
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Indoors
Outdoors
Where will they be kept when you are not at home?:
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Yard
Patio
Kennel
Garage
Other
If other, please Explain:
Doggy Door?
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Yes
No
Fenced?
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Yes
No
How high is your fence?
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What kind of fence?
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Wood
Chain link
Vinyl
Other
If other, please Explain:
Have/Would you use a pet-sitter or pet daycare center?
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Yes
No
When home, pet will be:
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always - indoors
mostly - indoors
always - outdoors
mostly - outdoors
Other
If other, please Explain:
If pet will be outside at all, what outside space is available?
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Garage
Dog run
Fenced yard
Unfenced yard
Yard
Balcony
Other
If other, please Explain:
How do you plan to handle pet’s exercise needs?
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Do you travel?
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Yes
No
How often?
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How long at a time?
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When you do travel, how do you intend to provide for the pet while you are gone?
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If a pet became destructive to your home, what would you do?
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Do you have any “musts” for a pet? If yes, please elaborate:
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What provisions would be made if you had to move? Locally?
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What provisions would be made if you had to move? Out of state?
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What provisions would be made if you had to move? Where no pets allowed?
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If adopting a dog:
Do you feel obedience training makes a dog a better companion?
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Yes
No
If necessary, are you willing to attend obedience classes at your expense?
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Yes
No
Under what circumstances would you not keep the dog? Click ALL that apply:
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Divorce
Family illness
Moving
New baby
Dog got too big
New job
Chewing
Kids ignore
Shedding
Medical bills
Allergy
Not obedient
Housetraining problem
Pets don't get along
Biting
Barking
Digging
None
Explain
What would you do if the dog grew to be bigger than you expected?
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Return to the rescue group
Take to a shelter
Take to dog pound
Give away
Nothing
Explain
A dog may live 15+ years. What would you do with your dog if you could no longer care for it?
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Additional Information
Is there anything else you would like to tell us about yourself or your home environment?
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Have you or any member of your household been investigated, arrested, charged or convicted of animal abuse or neglect? If yes, please explain.
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Yes
No
Explain
I desire to adopt the pet listed on this application. I understand, agree and represent:
I understand this is an application only and PAWSITIVELY RESCUED has the sole discretion, with or without cause, to accept or decline this application:
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Yes
No
I understand there is an adoption fee associated with an adoption to cover PAWSITIVELY RESCUED expenses for caring for the dog or cat prior to adoption?
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Yes
No
If any of the information changes I will advise PAWSITIVELY RESCUED promptly?
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Yes
No
Digital Signature
All of the information I have provided in this application is true and correct. Any false or misleading information may be grounds for denying the application or for the recovery of the pet at PAWSITIVELY RESCUED sole discretion. Your digital signature is required to confirm your understanding of all the terms and conditions stated here. Enter your PRINTED NAME AND MONTH AND YEAR OF BIRTH to affirm our digital signature (example: January 1950). If you prefer not to digitally sign the application, you will be required to physically sign the application to complete the adoption process. Thank you.
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TYPE YOUR FULL NAME FOLLOWED BY YOUR MONTH AND BIRTH YEAR
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