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 |