Dog Adoption Form – PAWS Humane Society

Notice: To be considered for an adoption you must:

Be at least 21 years old.
Have the knowledge and consent of all adults living with you.
If renting have written consent from your landlord to have a dog at the address listed.
Consent to a home visit.
Understand that PAWS Humane Society has the right to deny your application for any reason.

Name of dog you are interested in adoption: (required)

First Name (required)

Last Name (required)

Street Address (required)

Apt

City (required)

State (required)

ZIP Code (required)

Phone (required)

Cell Phone (required)

Email (required)

Date of Birth (mm/dd/yyyy) (required)

Are you? EmployedHomemakerStudentRetiredDisabled

Employer's Name

Work Phone

Where do you live? HouseApartmentCondoMobile HomeDormOther

Do you? OwnRentLive with ParentsOther

If other

If you rent, please provide the landlord's name and phone number so we can verify that cats are allowed:

Landlord's phone

How long have you lived at this address? Less than 2years2-5 years5+ years

Are you familiar with the pet responsibility laws in your area? YesNo

Are you willing to have a PAWS representative come to see where the dog will be living? YesNo

Please list all the members in your household:

1. Name

1. Relationship

1. Age

1. Their role in caring for your new pet

2. Name

2. Relationship

2. Age

2. Their role in caring for your new pet

3. Name

3. Relationship

3. Age

3. Their role in caring for your new pet

Does any member of your household have allergies? YesNo

Would this be your first dog? YesNo

Do you have a fenced yard? YesNo

If yes, type of fencing:

Have you ever applied for an adoption or adopted a pet from PAWS? YesNo

Why are you interested in adopting this dog? Companion for another petGiftTo breedCompanionship

Are you familiar with the needs of a dog? YesNo

Have you ever taken an animal to a shelter? YesNo

If yes, for what reason?

Dogs often live longer than 15 years, and you can expect to spend several hundred dollars a year to feed, vaccinate, license, and provide medical care for just one dog. Are you ready to be responsible for this dog for its entire life? YesNo

About your other/past pets

1. Pet’s Name

1. Type/Breed of animal

1. In or Out

1. Others

1. Age

1. Fixed?

1. GenderMaleFemale

1. Still own? YesNo

2. Pet’s Name

2. Type/Breed of animal

2. In or Out

2. Others

2. Age

2. Fixed?

2. GenderMaleFemale

2. Still own? YesNo

3. Pet’s Name

3. Type/Breed of animal

3. In or Out

3. Others

3. Age

3. Fixed?

3. GenderMaleFemale

3. Still own? YesNo

If you no longer have the pet(s) above, explain why:

Are all your pets up to date on shots and tags? YesNo

Who will care for your pet(s) if you travel?

ABOUT YOUR NEW PET

Your new pet may take a month or longer to adjust to its new home, especially if you own other pets. Are you willing to allow for this adjustment? YesNo

Where will the dog be kept during the day?

Where will the dog be kept during the night?

How many hours a day will your pet be without human companionship?

Please tell us why you would like to adopt this animal:

Please describe the most important characteristics and personality traits of your ideal pet.

If for some reason you can no longer keep this pet, do you understand that you must return it to PAWS? YesNo

If no, why?

How did you hear about PAWS Humane Society? (Check all that apply) TVRadioPet StorePetfinder.comFriendPAWSHS.orgFacebookPAWS NewsletterOther

If newspaper, state the name:

If friend, state the name:

If petstore, state the name:

References:

Veterinarian

Veterinarian Phone::

Do we have your permission to contact? YesNo

Please list 2 personal references:

1. Name of reference

1. Phone of reference

1. Relationship to reference

1. How long have you known this person

2. Name of reference

2. Phone of reference

2. Relationship to reference

2. How long have you known this person

By submitting this application, I certify that the above information is accurate and truthful. I understand that any misrepresentation of the above information can result in the withdrawal of my application for adoption. I understand that all adoptions done by PAWS are at the discretion of authorized representatives of the agency and completion of this form does not guarantee adoption