Application for a Dog

Name of Animal Interested In:__________________________                                                Date:_____________

PASF Adopter Profile (application for a dog)

Thank you. This information will help us find the best match for you and your family.

Name________________________________________  Spouse / Partner’s Name________________________

Address______________________________________  P.O. Box________  City________________________

ZIP_____________  Home Phone (_____) ______-_____________  Work Phone (_____) _____-___________

Email Address (print clearly) _____________________________Driver’s License #:____________________

Are you at least 18 years old?  … Yes  … No

Housing:            … House            … Apartment                     … Condominium                       … Mobile Home              … Military

Do You:            … Own                        … Rent                                 … Live with parents / other relative

How long have you lived at this address?____________    … Months            … Years

Number of people in the household:  ________Adults            ________Children (ages_____________________)

You and Your Household

Dog Experience:     … First Time Owner                      … Have Had 1 or 2            … Knowledgeable & Experienced

Household Activity Level:            … Quiet                      … Active                        … Very Active

Time Away From Home:            … 0-4 hours/day        … 4-6 hours/day                        … 6-8 hours/day          … 8+ hours/day

Reason for wanting a dog:____________________________________________________________________

List any animal allergies in the family:___________________________________________________________

Who will be primarily responsible for the dog’s care?_______________________________________________

How much do you expect to spend on the care of this dog each year?__________________________________

How much and what type(s) of exercise do you plan to provide?______________________________________

__________________________________________________________________________________________

Where will the dog be kept during the day?______________________  At night?________________________

Where will the dog be when people are home?____________________  When alone?_____________________

How will you keep the dog confined to your property?            … In house                … Supervision          … Fenced yard

… Chained                        … Garage                        … Kennel / dog run                … Other_____________________

Height of fence:___________                        Fencing material:__________________            Size of yard:_____________

Name of your veterinarian____________________________________________________________________

 

What would you do with the dog if you could no longer keep it?______________________________________

 

Hopes and Expectations for the Pet

 

Breed:__________________     Size:     … 2-9 lbs       … 10-24 lbs        … 25-49 lbs    … 50-90 lbs                … 90+ lbs

Coat:  … short                 … medium                … long      … no preference                   Sex:  … male         … female        … no preference

Age:   … 8-16 weeks                … 4-12 months       … 1-3 years                      … older                                     … no preference

The dog needs to be:     … calm                    … active                                  … good with dogs / cats            … housetrained

… no shedding       … obedience trained       … good with kids

PETS CURRENTLY IN YOUR HOUSEHOLD

Species

Age

Sex

Altered?

Kept Where?

Time Owned?

    … In           … Out          … Both
    … In           … Out          … Both
    … In           … Out          … Both

 PETS FORMERLY IN YOUR HOUSEHOLD (5 YEAR HISTORY)

Species

Sex

Altered?

Kept Where?

Time Owned?

What Happened?

 … In         … Out        … Both
 … In         … Out        … Both
 … In         … Out        … Both

 

Have you ever brought an animal to a shelter?            … Yes               … No

If yes, what were the circumstances?____________________________________________________________

 

I AGREE THAT THE ABOVE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND GIVE SHELTER STAFF PERMISSION TO VERIFY THIS INFORMATION.

 

_______________________________________________                                                            __________________

Adopter’s Signature                                                                                                           Date

For Staff Use Only

Application reviewed by:___________________________              Applicant approved for:_____________________

Comments:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Adoption Checklist

Needed?

Date Done

Comments

Landlord:Phone #:
Children/Spouse Meeting
Other Dog Meeting
Home Visit

Application Review

Initials

Date

Comments

Follow Up For Application filed on specific animal

 


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