Animal Type: DOG CAT
A#: ______
Animal Name: ______
Today’s Date: ______
ADOPTION/FOSTER APPLICATION
Primary Phone#: ______Alternate Phone#: ______Work#: ______
Name: ______Age:______
Street Address (no PO Box): ______City: ______
State: _____ Zip:______Occupation: ______Place of work: ______
E-mail: ______Who are you adopting this pet for? ______
1. Tell us about your household and why you have chosen a rescued pet? ______
2. What type of animal are you looking for? ______
3. Will everyone in your family be agreeable to the pet adoption? ______
4. Primarily, where will your pet be kept? Inside______Outside ______Both ______
5. Are there children in your household? ______If so, please list ages: ______
6. How many adults total live in your household? ______
7. Have they been taught to respect animals? ______
8. Do you have any animal allergies? ______
9. You live in a: Home _____ Apartment_____ Trailer_____ Other_____
10. How long have you been living at your current residence? ______
11. Do you own your own home? _____ If you rent, please list the name and phone number of your Landlord, who we may
contact: ______
12. How much is the pet deposit with your Landlord? ______Do you plan to move in the near future? ______
If so, what will you do with your adopted pet? ______
13. Are you truly prepared to make a lifetime commitment to this animal? ______
14. Have you owned an animal that has died in the last 12 months? If so, please explain: ______
______
15. Have you owned an animal that has gone missing in the last 12 months? If so, please explain: ______
______
16. All animals add to the housework. Are you prepared for the extra work required? ______
17. Are you aware of the extra time that it will take in the beginning to get your new pet accustomed to its new
surroundings, especially if there are other pet(s) involved? ______
18. Do you currently have other pets? If so please list: ______
19. Your current pets are (circle all that apply) : SPAYED NEUTERED VACCINATED REGISTERED
20. Until your new pet learns the rules of your home, it may have potty accidents in your home. Also, there is a
chance it may chew household items. Are you willing to accept this and lovingly devote the extra time
needed for house training and behavior training? ______
21. Who is your current Veterinarian? ______Phone #: ______
22. Are you aware of the ongoing expenses that occur when you own a pet?______
23. Are you aware of heartworm prevention? YES NO
If No, please notify a P.A.A.C. member so they can discuss it with you.
If Yes, what will you be using for heartworm prevention? ______
24. What will you use for flea and tick prevention? ______
25. Do we have your permission to contact your veterinarian and/or landlord?______
26. Are you agreeable to a home visit? ______If not, please explain: ______
______
27. Has anyone in the adopting household received a citation for misdemeanor or felony animal cruelty? YES NO
If Yes, please explain when and where: ______
28. Name of the pet you are interested in adopting: ______
I hereby certify that the above is true and correct to the best of my knowledge.
Signature: ______Date: ______
______
PAAC Adoption Application
Updated: 2/25/2013 Page 1 of 2