Full Name  *

Spouse

Email Address:  *

Phone Number:  *

Street Address:  *

City:  *

State:  *

Zip Code:  *

Occupation:  *

Spouse Occupation

What pet are you wanting to adopt?  *

How did you hear of us?

Why do you want to adopt a pet?  *

People in household:

# of Adults:  *

Age of adults:  *

# of children:  *

Ages of children:  *

Are all members in the home in agreement with adopting this pet? yesnohalf and half

Does anyone in the household have any allergies to pet hair/dander (select one)? YesNo

Will a growing family change your ability to home and care for your pet? noyesmaybeno plans to grow our family

Living quarters (select one)? Own homeOwn condoRent homeRent condoRent apartmentNone of the above

Are pets allowed (select one)? YESNO

Any restrictions? YESNO

If rent-landlord approval? YES NO

Is a yard available? YESNO

Yard Available:

What size is the yard?  *

Is it fenced in? YESNO

If you have a fence - how high is it?

If NO fence is available - how will you contain your pet outdoors?

Do you live in a high traffic area? YESNO

If you move and pets are not allowed - what will you do with your pet?  *

Hours a day pet will be left alone?  *

Where will the dog/puppy stay when left alone?  *

Where will the pet sleep?  *

Do you plan to take your dog/puppy to obedience training? YESNO

If adopting a cat - would you allow your cat to go outdoors? YESNO

If you experience behavioral problems with your pet what will you do?  *

Is this your first pet? YESNO

If you have/had other pets- provide the type of pet? male or female? spayed or neutered? current on vaccines? Age and current locations?

Current Veterinarian or Clinic?  *

May we call them? YESNO

Tell us about current and prior pets

Have you ever had to surrender a pet? yesno

If yes please explain

Phone number of current Veterinarian Clinic:  *

Will you provide annual OR AS NEEDED medical treatment and check-ups for your pet? YESNO

Are you prepared to start your new pet on heartworm prevention at the time of adoption? YESNO

Will you microchip your new pet?

Are you aware that additional vaccinations are necessary for your pet besides what is covered by the adoption fee? YESNO

Will your new pet be seen by a vet? YESNO

If YES When?

Two different references:

Name1 - Phone - Relationship  *

Name2 - Phone - Relationship  *

Will you contact PAAIN with any problems or concerns...or circumstance that may lead you to surrender your adopted pet? YESNO

What challenges and/or satisfaction will this pet bring to you and your family?

Additional comments to assist us in the adoption process:

Are you willing to accept a 24-48 hour waiting period (if needed ) for application approval? YESNO

Security code:   *

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