Dog Adoption Application
Name of Dog:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
**Adoption fee is payable with cash, check, and Credit/Debit cards + credit card surcharge**
**Filling out this application does not guarantee adoption approval. **
1.
*
First Name
Last Name
2.
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell phone:
*
Format: (000) 000-0000.
Home phone:
Format: (000) 000-0000.
Email address:
*
example@example.com
Are the potential adopters employed?
*
If No, please explain:
*
Do you own or rent?
*
If you rent, you must provide landlord's information below:.
Landlord's name and phone:
(If you rent, landlord approval is needed before the adoptable animal will be released to a home.)
Number of adults living in the home (18 yrs or older):
*
Number of children living full and/or part time in the home:
*
Ages of children:
Does anyone living in the household have animal related allergies?
*
You a first-time pet owner?
*
Is there a yard?
*
Is it fenced?
*
Have you ever had to re-home a pet before?
*
If yes, please explain:
Have you ever had to put a pet to sleep before?
*
If yes, please explain:
Are there any other pets that currently reside in your home? If yes, please list their breed and ages (if known):
*
Back
Next
If applicable, are they spayed or neutered?
*
If not, please explain:
Where do they stay (indoors, outdoors, etc.)?:
*
Have you ever been convicted of animal cruelty, domestic violence, sexual assault or child abuse?
*
There are financial responsibilities that comes with owning a pet. Besides food, treats and toys, there are annual veterinary exams and vaccines needed, chronic illnesses to care for and even unexpected emergency expenses. Can you afford to properly care for the adoptable animal?
*
Name of veterinary clinic that you currently use or intend on using:
*
What arrangements will you make for the care of the adoptable dog in case of emergency, or if you become unable to care for the pet?
*
If you move, will you make arrangements to take the dog with you?
*
Under what circumstances would you consider giving up a pet?
*
The Parma Animal Shelter, Inc. is a non-profit organization. Our animals are not for sale, they are for adoption, which means a home must meet the approval before adopting a pet, including but not limited to filling out this form, discussion(s) with an adoption counselor, meeting with the prospective pet and a signed contract. In addition, the Parma Animal Shelter, Inc. reserves the right to turn down the adoption at any time during this process for any reason.
I assert that the information I have provided on this form is accurate and true and have read and understand the above disclaimer. By signing this application, I understand that I am responsible for the well-being of the adoptable dog(s). I will provide proper care and shelter. I will not abandon the adoptable dog(s) at any time. Dogs/puppies must be transported with a leash and collar.
Signature of applicant:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of applicant:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
**Because you have signed this form does not mean you have been approved to adopt this animal.
Questions? Please contact
dogadoptions@parmashelter.org
This section is to be completed by a Parma Animal Shelter, Inc. Adoption Counselor ONLY.
Adoption Approved: Yes
No
Name of adoption counselor:
First Name
Last Name
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Notes:
Preview PDF
Submit
Should be Empty: