Adoption Application
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Email
example@example.com
Place of Employment
Which animal are you interested in adopting?
Why do you want to adopt an animal?
How long have you been looking for a pet?
What is it about this animal that appeals to you?
Who will be the primary caregiver of this pet?
Does anybody in your home have allergies (pets)?
Does anybody in your household smoke?
Have you adopted from another rescue/shelter in the past? If so, which one?
How many people are in your family? If you have children under 18, please list their age(s)
Is everybody in the family in agreement with the pet you want to adopt?
Yes or No
Are you aware of the financial obligation with the pet you want?
Yes or No
If your pet becomes sick, how much are you willing to spend?
Are you aware that this animal will require routine vet care including (but notlimited to) annual examinations and vaccinations?
Yes or No
Do you agree to obtain required annual vaccinations?
Yes or No
If the pet you are adopting is not house trained, what method will you use to use to help the pet succeed?
Are you prepared for this pet to have accidents in your home?
Yes or No
As an adult, have you ever been a pet owner?
Yes or No
Do you have any pets in your home now?
Yes or No
If YES, please list the Names, Ages, Breeds, and Sexes of your pets
Are your pets licensed and vaccinated?
Yes or No
Are your pets spayed/neutered?
YEs or No
Reason and approximate date of your last vet appointment?
Have you had other pets in the past five years? If YES, list the Age, Breed, Sex, and how long you owned the pet.
What happened to your previous pet(s)?
Have you ever given away, surrendered, or sold a pet? If so, please explain.
Accomodations
Do you...
Rent/Lease
Own
If you rent, do you rent...
Yearly
Monthly
Type of home you live in:
Apartment/Condo
Townhome
Single-family home
Rural
If you rent, what is the name of the complex/association/landlord?
If you rent, please attach a copy of the PET POLICY.
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If you rent, what is the name of your landlord/complex?
If you rent, what is the phone number of your landlord/complex?
How long have you been at your current address?
If you had to move, what would you do with your pet?
Do you intend to keep this animal inside, outside, or both?
Do you have a fenced-in backyard?
Yes or No
If YES, please explain what type and is the whole yard fenced in?
If there is no fence, please explain how you plan to contain, allow for bathroom breaks, exercise,etc. the pet you are adopting?
Where will this animal sleep at night?
How many hours per day (on average) will this animal be left alone?
Where will this animal stay while you are gone to work, weekend trips, holiday/vacation?
Will the pet be left outdoors when you are gone or at night? If so, please explain.
Are you familiar with animal regulations in your city?
Yes or No
Are you willing to make a commitment to provide for this animal for its entire lifespan?
Yes or No
Do you have a history of human or animal abuse or been convicted of a crime against either?
Yes or No
If YES, please explain.
Initial below if you agree to contact Prairie Paws Rescue if you can no longer keep the pet you're adopting.
References
Vet references or NON-relative references suggested
Please provide 2 references (NON-relative) with Name and Phone Number
If you're currently a pet owner, list the Name and Phone Number of your vet.
Initial below if you understand that a home visit may be conducted prior to placement of this animal.
Any additional comments?
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