EmailMe Form - Dog/Puppy Adoption Application

Dog/Puppy's Name (If unsure, please note "Open to Suggestions" *

Sex of Dog/Puppy

Male

Female

Information About You

Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Phone

### - ### - ####

Email *

Are you at least 18 years of age? *

Are you currently employed? *

Please provide the name of Employer *

How long have you worked there? *

Do you have any circumstances that would limit your ability to care for this animal? *

If yes, please explain

Information About Your Household

What best describes where you live (check all that apply)? *

Do you have a fenced in yard? *

Yes

No

Do you own or rent? *

If you rent, please give Landlord's name and number

List ALL household members (children's ages)

How would you describe your household? *

Is anyone in the household allergic to pets? *

How many hours will the pet be alone? *

Where will the pet be at this time? *

Do ALL family members agree about this adoption? *

Pet History

Please list ALL pets you currently own (N/A if not applicable).

PLEASE NOTE: ALL dogs/cats currently in the household MUST be utd on vaccines and spayed/neutered unless veterinarian can verify a health reason. *

Are they up to date on vaccines? *

Spayed/Neutered? *

If no, please explain

Please list pets you have had in the past 5 years that are no longer with you

Please list current veterinarian (N/A if not applicable)
PLEASE NOTE: You MUST contact your vet and give permission to release information to PPAR. Failure to do so may put your application at the end of the line. *

Current Vet's Phone Number (000-000-0000 if not applicable). You MUST give your vet permission to release information. Failure to do so will delay your application. *

### - ### - ####

Who do you plan to use as your veterinarian? *

What will you do with your dog when you go on vacation? *

What will you do with your dog if you move? *

Briefly explain why you wish to adopt *

What percentage of the time will the dog be outside? *

Please list a personal reference with contact number *

Waiver

By submitting this document, I attest that the information given is true and I understand that giving false or incomplete information may result in this application being denied.

I understand that PPAR makes no guarantee of the health, habits, temperament or any other fact about the animal. *

Agree

Disagree

In adopting this animal, I agree to keep my pet current on rabies vaccinations. *

Agree

Disagree

If not already altered, I agree to have this pet spayed/neutered unless otherwise recommended by a veterinarian. In ordered for spay/neuter to be covered under PPAR, appointment will be scheduled by a PPAR rep with one of their approved veterinarians. *

Agree

Disagree

I can afford and agree to provide food, indoor housing and routine veterinary care for this animal. *

Agree

Disagree

I see this animal as a lifelong commitment and family member. *

Agree

Disagree

THANK YOU FOR CHOOSING PAWZ & PURRZ ANIMAL RESCUE

Please understand, we do not go by first come, first serve. Some dogs may have several applications, which makes the process time longer than usual. If you do not hear from someone within a week, please feel free to call.