Please Have: Identification Showing Your Present Address, and Be Able to Spend the Time

Please have: Identification showing your present address, and be able to spend the time and money necessary to provide proper care of the dog.

Date: ______Dog that you are interested in: ______

Name: ______

Address: ______

City, State: ______Zip: ______

Cell Phone: ______Email: ______

Personal Reference

Name:______Phone ______

Previous & Current Pets

Have you ever given an animal to a family member or animal shelter? ______

List all Pets that you have owned in the last 5 years: (if you need more room, please use the back)

Dog or Cat / Name / Age / Male/
Female / Spayed/
Neutered / Comments

Please check the one that best describes your home.

( ) House with fenced yard

( ) House with outside Kennel

( ) Apartment without yard

( ) Home with an unfenced yard

( ) Other (please explain) ______

If you rent, Provide the name and phone number your property manager: ______

Please describe your household: __ Active __ Noisy __ Quiet __ Average

Who will be the primary caregiver of the dog? ______

How will you discipline the dog for undesired behaviors?______

Are you aware that even housetrained dogs need a period of two-to-six-months to acclimate in a new home? ______

Is there a time when the animal will be tied up? ______

Do you have a fenced yard?

______

Number of hours dog will spend alone daily? ______Are you prepared to provide a lifetime commitment of time, finances for this dog? ______Where will the dog sleep? ______

How did you find out about us? ______

Signature: ______Date: ______

Please read and initial.

______I have filled out this paperwork honestly. I understand that omission of information and/or failure to answer all questions and sign this paperwork can result in being declined and agree that this is not arbitrary.

______If an omission or untruth is discovered after an adoption takes place, I understand that PCPS reserves the right to annul the adoption and reclaim the animal. I give permission to fully investigate the information provided.

______This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.

______I further understand that no representations are made as to the temperamental or mental disposition of the dog. Accordingly, I hereby adopt the dog at my own risk.

______I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal.

______Our goal is to place animals in forever homes. It can be difficult for an animal to make the transition to a new home, only to be brought back to the shelter, so we encourage you to consider your choice of pet carefully before making a final decision. We have a no refund policy.

______If at any time you can no longer care for your adopted dog, you may return the dog. Please contact us so that we can schedule an appointment for the dog to be returned. If you know of a suitable home, a shelter representative will need to approve the new home.

Signature: ______Date: ______

Sh 2018