Zip Code

Phone: (list all)

List all members of your household, including yourself (PLEASE LIST AGES OF EVERYONE)

Please list all domestic animals currently living in your household.  Name  Dog/Cat Breed  Age Sex Spayed/Neutered

Address:

How did you acquire your current pets?

Please list all pets you have had in the past 5 years that no longer live with you and where are they now.

Name  Dog/Cat Breed  Age Sex Spayed/Neutered

Do your current pets live indoors? If not what type of protection for the elements is provided for them:

Other information you would like to share about your household:

Why do you want to adopt a pet?

Have you submitted an application with another organization for a pet at this time?

Have you ever had an application declined for adoption of an animal from an animal welfare group/animal control facility? If no, skip to the next question.  If yes, explain:

Are you willing to take the time to house train a dog, and do you understand that changing a dog or cat’s environment may cause the pet to have accidents?    

If a behavioral problem arises, what steps will you take to remedy it?

Does any member of the family have any allergies to animals?  If no, skip to the next question. If yes, explain.    

Describe the kinds of personal situations where you might have to return your adopted  pet, i.e., job loss, children, move, marital change, etc.

Who will be responsible for feeding and taking the dog outside?

Who will take care of the pet in the absence of the primary caretaker?

Will you take your dog to obedience training?

List the name and phone number of the Veterinarian where the animals vaccination records are being maintained. Veterinarian/Animal Hospital name.  Please be sure to list Phone, Address, Name of Pet, Last date of visit, and owner’s name that the records are listed.

Other Veterinarians or Clinic your pets may have seen in the last 5 years. Be sure to list their phone number as well.

PLEASE NOTE:  You are required to sign below this statement which will authorize your vet to release medical information on any and all pets listed under my name to an Angel Paws representative.  If you do not wish us to contact your vet and obtain medical history on your pets (past and present) we cannot process or approve your application.  

MEDICAL RELEASE AUTHORIZATION

I hereby authorize the vet(s) listed above to release any and all medical information on any and all pets listed under my name for the sole purpose of determining my eligibility to adopt a pet from Angel Paws Adoption Center

Electronic Signature

Date:

What kind of veterinary care do you plan to provide?

The costs of maintaining a physically and emotionally healthy pet can average $500 or more annually. Have you considered the extra expenses that will come with having a pet, including routine and emergency vet care, food, supplies and equipment, toys, training and boarding? Please explain:

What type of home do you live in?

Do you own or rent your residence?

How long at current address

If you rent: Landlord name & phone # :

Do you have a fenced yard?  If no, skip to the next question.  If yes, please provide what type of fencing you have.

How often will you exercise the dog and for approximately how long? (Dog only)

How many hours will the dog be left unattended (i.e., workday)?(Dog only)

When you are home, where will the pet be kept?

Where will the pet sleep?

When no one is home (i.e. at work, shopping), where will the pet stay (be specific)?

How often do you travel?

What arrangements will you make for your pet when you travel?

If you move, what will you do with the pet?

Have all adult family members agreed to adopt a pet?

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application may result in delayed processing of the application. I give APAC permission to verify the information provided as well as contact veterinarians and other listed contacts. If the application passes this review, I understand a home and yard visit may be requested by APAC before an adoption decision is made.

In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received for this animal.

Electronic Signature

Date:

OPT TO ADOPT PLEASE SPAY/NEUTER YOUR PETS

Name of Applicant:

Date:

Age of Applicant

Name of Desired Pet

City

State

Place of employment:

Occupation:

Work Telephone

E-mail Address