People United for Pets (PUP)
Adoption Application and Agreement
10/12/2018
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Thank you for contacting our rescue! Our goal is to adopt loving dogs to responsible, loving, permanent homes.
We would appreciate your help in filling out this form so we may find out more about you and your family!
First Name: Last Name:Today’s Date:
StreetAddress: City: State: Zip Code: Home Phone: E-mail Address:
Occupation: Employer: WorkPhone: Cell Phone: Best Times to Reach You:
First Name (Spouse/Partner): Last Name: E-mail Address:
Occupation: Employer: WorkPhone: Cell Phone: Best Times to Reach You:
In which dog or dogs are you interested? First choice:Second choice:
If these choices are not available, what age do you prefer? Breed?Male or Female?
What activity level are you looking for in a new dog?
Low=Couch Potato Medium=Enjoys Walks High=Wants to Go, Go, Go
What other characteristics are important to you? Please list.
I understand there will be an adoption fee that includes worming, flea treatment, microchip, vaccinations, teeth cleaning (if needed) and altering. Yes or No
I understand that PUP does not refund adoption fees. Yes or No
I agree to a pre-adoption home visit. Yes or No
How did you hear about PUP – Petfinder? Adopt a Pet? Other? (Please specify)
I agree that this dog WILL be an INDOOR pet and will not be left unattended outside. Yes or No
Your vet will be contacted as a reference to confirm ALL your pets’ current vaccination and spay or neuter status.
Please list multiple vets, if necessary for reference.
I have contacted my vet(s) and given them permission to release information to PUP.Yes or No
Veterinarian's Name: Address (please include city): Veterinarian's Phone Number:
Please provide the name your pet(s) records are listed under if not the names above.
If you do not have a vet, do you agree to provide PUP with this information within 2 weeks of adoption? Yes or No
If you do not have a current vet but have had one in the past, please list your former vet's contact information above.
Theykeep oldrecords on file for several yearsand it will still be helpful in the approval process.
What is the age of the primary person that will care for the dog you want to adopt?
How many adults reside in your home? What are their ages?
How many children reside in your home? What are their ages?
Do children visit your home?Yes or No What are the ages of visiting children?
Does everyone in your household want this dog? Yes or No
Does anyone in your household have pet allergies? Yes or No If yes, what type?
Do you live in a house/apartment/condo/mobile home? Do you own or rent your home?
If renting, do you have permission from the landlord to have a pet? Yes or No
LandlordName: Landlord PhoneNumber or Email Address:
Do you have a fenced yard? Yes or No If yes, what type of fence?
Will the fence securely contain a small dog? Yes or No How high is the fence?
If a securely fenced yard is not available, how will you handle exercise and toilet duties?
Do you have a pool? Yes or No If yes, is there a fence around it? Please describe.
Do you work outside the home? Yes or No Will the dog be without human company while you are at work? Yes or No
If yes,will the dog be alone for 4 or more hours at a time? Yes orNo If yes, where will the dog be kept?
If you work outside the home and the dog will not be alone, who will be with the dog?
Where will the dog be kept whenever you are gone? Loose indoors/gated area/crate/garage/other, please describe.
When you go on vacation, where will the dog be kept?
What would happen to the dog, should you decide to move?
Do you own a dog now? Yes or No
Please describe for each dog currently in your home:
Name / Breed / Gender / Age / Spayed/Neutered? Yes or No / Description of Activity Level and Temperament
Besides dogs, do you have any other pets? YesorNo
If yes, what are they (cats, ferrets, rabbits, etc.):
Name / Type of Pet / Gender / Age / Spayed/Neutered? Yes or No / If cats, are they indoor, outdoor, or both?
Have you owned any other pets in the last 10 years? YesorNo
Please describe:
Name / Type of Pet / Breed Type / Gender / Age / Spayed/Neutered? Yes or No / Date, if deceased / Where is pet now?
If you have not owned a dog(s) in the past 10 years, whatdog experience or knowledge do you have?
Have you ever had to rehome a dog or cat? Yes or No
If yes, please explain. If no, what circumstances might cause you to rehome a pet?
Are you aware that a dog can live upwards of 18 years and are you committed to care for it that long? Yes or No
Are you awaresome long coated dogs require grooming; and all require ear and nail care? Yes or No
Are you awarea dog can shed 365 days a year? Yes or No
Would you be willing to housebreak a dog if necessary? Yes or No
Are you familiar with dog health problems? Yes or No If yes, please describe.
Are you willing to administer daily medication should a health condition require it? Yes or No
What is your philosophy regarding dogs who develop medical problems and, as an owner, how would you approach the situation?
Why do you want a rescued pet?
What methods of correcting behavioral issues such as barking, chewing, soiling would you use with a new dog?
Important Health and Temperament Notice: We make no explicit or implicit guarantees in reference to the health and/or temperament of the dog. The dog is adopted "as is" and the adopter assumes all responsibility for treatment of any and all existing conditions or any other conditions of physical or temperament changes that may occur. People United for Pets will provide the dog with the basic vaccines before adoption if the age and current health of the dog permits. While People United for Pets makes every effort to place only healthy animals, we cannot guarantee the health of any animal and shall not be held responsible for any medical expenses which may be incurred, hereby expressly excluding any implied or express warranties of merchantability or fitness for any particular purpose, including, without limitation, any warranties regarding health, temperament or whether the animal is housebroken.
I am at least twenty-one (21) years old and ready to adopt.
Initials and date ==>
I agree that this dog WILL be an INDOOR pet and will not be left unattended outside.
Initials and date==>
If this is a puppy adoption, I agree to honor the conditions listed in the spay/neuter agreement. Initials and date===>
I agree if for ANY reason the dog I adoptDOES NOT work out, I will CONTACT People United for Pets to discuss rehoming options.
Initials and date==>
I, the adopter, agree to accept all responsibility for any harm caused by the dog to humans, other animals or personal property following adoption, including, without limitation, any damages resulting from bites, scratches, or any other form of aggression, and any damages resulting from the dog's failure to become housebroken.Initials and date==>
Indicates Response Required
CONFIDENTIAL
Please send the completed application to:
People United for Pets
PO Box 1691
Issaquah, WA 98027
Please leave the area below blank when submitting your application. At the time of adoption, you will be asked to complete the process by signing and dating your application.
Adopted by: ______Date: ______
Adopted by: ______Date: ______
Adopted by: ______Date: ______
Adopted by: ______Date: ______
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