P-U-R-R-S and Pups Adoption Application

Thank you for interest in rescuing an animal and for taking the time to complete this application. We appreciate your honesty in answering all of the following questions. Incomplete applications can not be considered. Review of the information you provide will assist us in matching the appropriate pet to your lifestyle. Our main concern is the future health and well being of all the animals in our care.

**Please note that Submission of this application does not guarantee an adoption**


Last Name: First:

Address: City: State: Zip:

Phone(Home): (Work): (Cell):

Email:

I am interested in adopting a pet   fostering a pet   volunteering my services

How did you hear about P-U-R-R-S and Pups Animal Rescue Team?
(Please choose all that apply)

Internet Newspaper Petco Friend/Relative/Other Adopted from P-U-R-R-S and Pups before

May we contact you in regards to upcoming events and promotions? Yes No

Name of animal from Website: Dog Cat Other

How long have you been looking for this type of pet?:

1. Who will be responsible for the pet?

2. Have you ever had a pet before? Yes No
If yes, please fill in all details below:

Pet#1 name: Type: Age:
Owned from / / to / /
Reason pet is no longer in your care:

Pet#2 name: Type: Age:
Owned from / / to / /
Reason pet is no longer in your care:

Pet#3 name: Type: Age:
Owned from / / to / /
Reason pet is no longer in your care:

3. Do you live with other pets at home? Yes No
If yes, please complete the following:

Pet#1 name: Type: Altered/Neutered? Yes No    Vaccinated? Yes No
Where Kept?

Pet#2 name: Type: Altered/Neutered? Yes No    Vaccinated? Yes No
Where Kept?

Pet#3 name: Type: Altered/Neutered? Yes No    Vaccinated? Yes No
Where Kept?

Pet#4 name: Type: Altered/Neutered? Yes No    Vaccinated? Yes No
Where Kept?

4. How often do you take your pet to the Veterinarian?
If "other" is selected, please explain:

a. Date of last visit? / /
b. Name of Vet?
c. Address: City: State: Zip:
d. Vet's phone number? - -

5. I live in a

a. Rent or Own? Rent Own
b. Landlord's name?
c. Landlord's phone number? - -

6. How long have you lived at your current address?

7. How may people live in your household?
Please fill in the information below:
a. Name: Adult Child    Age:
b. Name: Adult Child    Age:
c. Name: Adult Child    Age:
d. Name: Adult Child    Age:
e. Name: Adult Child    Age:

8. What is the longest period of time the animal will be left alone?

a. Where will the animal be kept during this time?

b. Where will the animal be kept when the family is home?

c. How many hours will the pet be allowed to play outside?

d. What will you do if the pet gets lost?

e. What would you do if your pet chews the furniture or displays other destructive behavior?


9. What is your reason for adopting this animal?
      (Please choose all that apply)

House Pet Guard Dog Watch Dog Companion Pet Companion Backyard Pet Gift Breeder
Other
If "other" was selected, please explain:

10. Please choose yes or no for the following questions:
a. Are you familiar with housebreaking? Yes No
b. Are you familiar with crate training? Yes No
c. Are you familiar with licensing laws in your community? Yes No

11. Does your yard have a fence? Yes No   If yes, how high?    Type:

12. Are you willing to allow us to make a home visit to verify your application? Yes No

13. Are you willing to agree to 3-month, 6-month and yearly follow up visits? Yes No

14. Please provide one personal reference who can recommend you as a responsible pet owner:
Name:
Phone: - -
Relationship to applicant:

15. Please provide the name of the person that will care for this pet if you are no longer able to:
Name:
Phone: - -
Relationship to applicant:

By submitting this application, you certify that you understand and agree to the following:

§   P-U-R-R-S and Pups representatives may contact anyone listed on this form.
§   You have answered all questions honestly and accurately.
§   P-U-R-R-S and Pups reserves the right to refuse any adoption without further explanation.