PAWS dog/puppy most interested in:

First Name:

Last Name:

Address:

Apartment/Unit #:

State:

City:

Zip Code:

Home Phone:

E-mail Address:

Employer:

Occupation:

Spouse's Name:

Spouse / other adult employer:

Spouse / other adult occupation:

Name of Personal Reference:

Relationship:

Phone:

# of Adults in Household:

# of Children:

Ages of Children (Please separate ages with commas):

Are all the adults in the household aware that you are adopting a dog / puppy?:

Who will have primary responsibility for this pet?:

Primary caregivers age:

Does anyone in the household have pet allergies or asthma?:

If Yes, who?:

Why did you choose this particular dog / puppy?:

Residence Type:

If you rent, does your lease allow animals?:

Are there any weight/breed restrictions?:

If yes, please describe:

Management company or landlord name:

Management company or landlord phone:

Is your yard fenced?:

If Yes, what is the height?:

Type of fence:

If your yard is NOT fenced, are you willing to fence it in?:

If No, what method of restraint do you intend to use?:

Do you have a pool?:

If Yes, it is:

Is there a fence around it?:

Will this dog be allowed outside unattended during the day / night?:

Do you have a doghouse or outside pen / kennel?:

Will this dog ride in the back of a pick-up truck?:

How many hours a day will the dog / puppy be left alone?:

Where will the dog / puppy be kept when you are home?:

Where will the dog / puppy sleep at night?:

How often and what kind of exercise will you give the dog / puppy?:

Are there times when your dog / puppy will be tied outside?:

Do you travel or relocate frequently?:

If Yes, please explain:

What will you do with your dog / puppy if you have to move?:

Please list the animals you currently have (Please list Name, Species, Age, M/F, Spayed/Neutered, Vaccinations Up to Date, Where is the animal Now?):

Please list the animals you have had in the past as an adult: (Please list Name, Species, Age, M/F, Spayed/Neutered, Vaccinations Up to Date, Where is the animal Now?):

What heartworm preventative have you given your dogs?:

What flea & tick treatment have you given your dogs?:

Have you ever given away, sold, or surrendered an animal?:

If the answer is Yes, what were the circumstances and to whom?:

What method of training / discipline will you use?:

How were your previous pets trained / disciplined?:

Some animals are either Not housetrained, or, when introduced to new surroundings, stressed or as an attention getter, will have housetraining issues. Are you prepared to deal with this?:

How will you correct him / her if an accident occurs?:

What method do you intend to use for housetraining?:

How long do you think it takes to housetrain a dog / puppy?:

Do you know how dogs get heartworm disease?:

Have you ever applied to adopt from a rescue organization, SPCA, animal shelter or Humane Society before?:

If yes, How?:

Explain the outcome:

If Yes, when?...:

Are you willing to allow a representative of PAWS to visit where your dog / puppy will be living?:

Are you willing to allow a representative of PAWS to contact your personal veterinarian?:

If Yes, veterinarian name:

Veterinarian's Phone:

I certify that the information above is true and understand that false information will result in nullification of adoption. Please enter your full name.: