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Dog Adoption Application
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Name of Pet that you are inquiring about (note "wishlist" if no particular pet):
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Co-Applicant (Spouse, etc.)
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Name (primary applicant)
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Address
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ZIP
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City
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State
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Home Phone
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Work Phone
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Mobile/Other
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Email
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own
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rent
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1. Current residence:
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no
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Weight limit in rental agreement:
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yes
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If renting, is landlord OK with pets?
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2. Do you have a fenced yard?
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yes
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Height and type of fence:
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If no, how will excercise/toilet be addressed?
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no
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3. Are all members of household agreeable to the idea of
adopting a rescued animal(s)?
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4. Do any members of your household have or have ever
had known allergies to dogs or cats? If yes, explain.
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5. Do you have children or grandchildren?
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Ages?
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yes
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no
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6. Do you own any other pets?
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no
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yes
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If yes, please provide age and breed:
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Are they fixed?
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If no, please explain:
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yes
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no
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Do they stay inside or outside?
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If you have a dog, what type of heartworm preventative do you use?
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Please provide history of previous pets: did they die, run away, were they stolen, etc.
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7. Are you looking for an inside or outside pet?
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8. Name, address and telephone number
of your current or previous veterinarian:
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9. Provide your work schedule and
spouse/roomate's work schedule (if applicable)
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Further comments and info that you think might
help us find the right dog/puppy for you,
including more about your preferences and
reasons for wanting a new pet:
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I hereby testify that I am financially and physically able to care for this dog. I understand that proper food, veterinary care, bedding,
toys, crate and so on can be costly and I am able to meet these requirements. (Applicants under 18 yrs of age, must have the
approval of a parent/guardian).
I understand that if the information contained herein is found to be intentionally falsified, my application can be refused or said
adopted dog shall be relinquished to PAS, Inc without a refund of the Adoption Fee.
*Notice: This is a pre-adoption interview and not an adoption contract, completion of interview does not guarantee placement of pet(s).
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I have read and understood and accept the Terms of Agreement.
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