PRICELESS PETS ADOPTION APPLICATION
PERSONAL INFORMATION (Please Print Clearly)
Name (Applicant):Age:Age(s):
Telephone: (HM)(Cell)Email:
Occupation:Employer:How long:
Current Address:City:State:Zip:
Name (Co-Applicant):Age:Relation to Applicant:Age(s):
Telephone: (HM)(Cell)Email:
Occupation:Employer:How long:
Current Address:City:State:Zip:
Are you interested in a specific pet? Yes ___ No ___ If Yes, name of Pet(s): ______
RESIDENCE INFORMATION
Where do you live? Apartment ___ House ___ Condo/Townhouse ___ Other ______(describe)
Do you: Rent ___ Own ___
How long have you lived at your current address? ______
If you rent, do you have the landlord's permission to own a pet? Yes ___ No ___ Is a security fee / pet deposit required? Yes ___ No ___
How often have you moved in the past 6 years? ______
If you move, will your pet go with you? Yes ___ No ___
Do you have a fenced yard with no gaps? Yes ___ No ___ If yes, how high? _____ feet Type of Fence: ______
Do you have a dog door? Yes ___ No ___
HOUSEHOLD INFORMATION
Number of adults {other than applicant(s)} in household? _____ Relationship to applicant(s): grown children___ roommates ___ other ___
Are thereany minorchildren in the household? Yes___ No___ If yes, please list gender and ages: ______
Do all family members know that you are applying to adopt a dog? Yes ___ No ___
Do any family members have animal allergies? Yes ___ No ___ If yes, please describe.
Do you or anyone you live with currently have any serious health problems? Yes ___ No ___ If yes, please explain:
Do you foresee any major changes in your life in the next 15 years (average lifespan of a dog) such as marriage, children, health problems due to age,
going away to college? Yes ___ No ___ If yes, please explain: ______
CURRENT AND PAST PET INFORMATION
Do you currently own pet(s)? Yes ___ No ___ If yes, please list Name, Type of Animal, Breed, Age, and Sex: ______
______
How many pets have you owned in the past 5 years? Dogs _____, Cats _____, Other _____
Where are these pets now? (Please be specific: ie alive, dead, put to sleep, sold, ran away, given away, etc.) ______
______
Do any of your current / past pets live mostly outdoors? Yes ___ No ___ If yes, please describe. ______
Where do your current pets stay when you're gone during the day? ______
Where do your current pets sleep at night? ______
Are current pets spayed / neutered? Yes ___ No ___ Were previous pets spayed / neutered? Yes ___ No ___
Are current pets up to date on vaccinations? Yes ___ No ___ Were previous pets kept current on vaccinations? Yes ___ No ___
Is your current dog (or was your previous dog) on heartworm prevention medication? Yes ___ No ___
If yes, how often do / did you give the heartworm prevention medication? ______What brand do / did you use? ______
How do you plan to prevent fleas and ticks? ______
Has a dog died on your premises due to Distemper, Parvo or unknown causes in the past 6 months? Yes ___ No ___
Have you ever had a serious behavior problem with a pet? Yes ___ No ___ If yes, please explain:
What is the name and telephone number of your Veterinarian ? ______
Can we contact them for verification? Yes ___ No ___ Phone: ______
PLANS FOR NEW PET
Please check any of the following reasons for adopting this pet: Family Pet ___ Companion ___ Watchdog ___ Gift ___ Hunting dog ___
Companion for Other Pet ___ For the Kids ___ Other (Explain) ______
How many hours will the pet be home alone on a typical day? 0-3 hrs ___ 3-5 hrs ___ 5-6 hrs ___ 6-8 hrs ___ 8-10 hrs ___ 10 + hrs ___
Where will the new dog stay when home alone during the day? Outside in Fenced Area ___ Outside in Dog Pen ___ Outside on a Chain or
Tie-Out ___ In Crate ___ In the Basement ___ In the Garage ___ Free Run of the House ___ Other (describe) ______
Where will the new pet sleep at night? In Crate in Bedroom ___ Your Bed ___ Doghouse in Fenced Area ___ Doghouse in Dog Run ___
Doghouse with Tie-Out ___ In the Basement ___ In the Garage ___ Free Run of House ___ In One Room of House ___
Other ___ (describe)
If you do not have a fence, how do you intend to keep your pet on your property? Chain ___ Runner ___ Tie-Out ___ Leash Walk ___
Pen / Kennel ___ Run Free ___ Other (explain) ______
Will the pet be allowed on the furniture? Yes ___ No ___ Some ___
Will the pet have access to the entire house? Yes ___ No ___ If no, where will pet be allowed? ______
Who will be the primary caregiver for the new dog? ______
What percentage of time will the dog spend inside the house? ______% Where will it spend the rest of its time? ______
What procedure(s) will you use for housebreaking? Crate ___ Rub Nose in Accidents ___ Swatting with rolled up newspaper ___
Keep Pet Outside Only ___ Other (Explain) ______
How will you train the dog not to be destructive (e.g., chewing, scratching, digging, excessive barking)? Loud Noise ___ Water Squirt Bottle ___
Swatting with rolled up newspaper ___ Noise Can ___ Other (explain) ______
How much do you expect routine vet care (vaccinations, deworming, heartworm preventative and flea preventative) will cost yearly? ______
Under what circumstances do you think it is OK to leave a dog unattended outside in an unfenced area? In a Quiet Subdivision ___
On a lot of Acreage ___ Invisible Fence ___ When I Know It is Trained to Always Come Back ___ None ___ Other ___ (describe)
What circumstances might cause you to give your dog up? Moving ___ New Baby ___ Not Getting Along With Other Pets ___ Divorce ___
Getting Out of Fence ___ Gets Too Big ___ Behavioral Problems ___ Children Lost Interest ___ Not Enough Time for It ___
Shedding ___ Allergies ___ Barking ___ Not Housebroken ___ Want to Travel ___ Medical Problems ___ None ___
Other ___ (describe)
If you adopt a dog with long hair, how often will you groom this dog?______
Will it get haircuts? Yes ___ No ___ Will you: Do it yourself? ___ Take to a Groomer? ___
Suppose your pet develops a medical problem that becomes expensive. What would you do? Find Another Home for It ___
Pay Whatever it Takes ___ Have It Put to Sleep ___ Give It to Rescue Group ___ Give It to Humane Society ___
Give It to Animal Control ___ Other ___ (describe)
Suppose your pet develops a frequent urination problem or incontinence as it ages. What would you do? Have it Put to Sleep, Since It is Older ___
Baby Gate It in Where Flooring is Not Carpeted ___ Put It Outside ___ Give It to Rescue Group ___ Give It to Humane Society ___
Give It to Animal Control ___ Put in a doggie door ___ Other ___ (describe)
By signing below, I am attesting to the truthfulness of my answers.
APPLICANT:______
Signature (must be 23 years of age or older unless otherwise approved by Priceless Pets)Date
CO-APPLICANT:______
Signature (must be 23 years of age or older unless otherwise approved by Priceless Pets)Date