Palmetto Paws Animal Rescue

Thank you for your interest. Completion of this form does not guarantee that you will receive an animal from us. There are many things that we take into consideration when reviewing applications. We reserve the right to deny any applicant. Our goal is to match the right animal with the right home. Incomplete applications will not be considered.

Are you interested in:

Name of animal for which you are completing this application:*

Date

Your name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Alternate Phone Number

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Are you?*

MarriedSingle

If married, spouse's name:

What is your occupation?*

What is your spouse's occupation?

List AGES of all people living in your home, including yourself: *

Where do you live?*

Do you own or rent your home?*

OwnRent

If you rent, please provide your landlord's name and contact information:

Are there any breed restrictions/HOA restrictions where you reside? Please review your HOA and lease documents if indicated.*

If you move, will you be sure to secure housing that will accommodate your pet? *

Who will be responsible for the welfare of the animal?*

Does anyone in the household have allergies to pets? If yes, please explain.*

Do you prefer:*

MaleFemaleEither

Why?*

Are you interested in:*

PuppyAdult

Why?*

Are you interested in:*

KittenOlder cat

Why?*

Are you committed to caring for this animal for its lifetime? This includes moving with your pet, working through training issues, managing health issues, and making this et an unconditional lifetime family member?*

If something should happen to you, what arrangements have you made for your pet(s)?*

How much money are you prepared to spend should a major health issue/accident happen?*

How much time will the animal be left alone?*

Where will the animal stay during the day?*

Will your cat live:*

InsideOutsideBoth

If you are looking to adopt a puppy less than 3-4 months of age, and you are gone longer than four hours at a time, what arrangements have you made for the puppy?*

Where will the dog sleep?*

Where will the cat sleep?*

Are you familiar with crate training?*

YesNo

Do you have a fenced in yard?*

YesNo

If yes, fence type and height

Do you plan to chain, tether, or put the dog on an overhead runner?*

YesNo

Do you own any pets?*

YesNo

Tell us about your pets:

Are all of your current pets up to date on vaccines?*

YesNo

If you have dogs, are they current on heartworm prevention?*

YesNo

What type of heartworm prevention is being used and where is it purchased from if different from your vet?*

List all previously owned pets in the last 5 years and the reason that you no longer have them:

If you have dogs, are they current on heartworm prevention?*

YesNo

Tell us what you know about heartworm disease. Your answer MUST include prevention, treatment, and prevalence in this area. *If you are unfamiliar with heartworm disease, it is expected that you conduct research to fully answer the above question.**

Who is your current or prior veterinarian?*

Phone Number*

Please enter a valid phone number.

What owner name are the vet records/pets under?*

How do you correct unwanted behaviors in a dog? Please give an example.*

Have you ever taken a dog to obedience classes?*

YesNo

If yes, where?

Please tell us anything else about yourself that you would like us to consider in the adoption process?*

How did you learn about our organization?*

If your application is approved, are you able to meet and potentially adopt this Saturday at a time designated by the rescue?*

By clicking submit, I affirm that the information provided is true and correct to the best of my knowledge. I authorize the veterinarian listed above to release medical information of my current or prior pets.
I understand that completion of this application does not guarantee I will be approved to adopt.

Date

Signature