* First Name:
* Last Name:
* Street Address:
Address (cont.):
* City:
* State/Province:
* Zip/Postal Code:
* Country:
* Home Phone:
E-mail:
* Are you over 18 years of age?
Yes
No
Employed:
Full Time
Part Time
Retired
Employed By:
* Does anyone in your household work full time?
Yes
No
* Do you live in a
House
Apartment
Condo
Mobile Home
Townhouse
* Do you
Own
Rent
Live with parent
Live with Relative
* If you rent, are you prepared to pay a pet deposit?
Yes
No
* If you rent, Landlord Phone # (if renting)
* How long at current address?
- Select one -
Less than 1 year
More than 1 year
1-2 years
2-3 years
3-4 years
4-5 years
5+ years
* Number of persons in household:
- select -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
more than 15
* Planning to change residence in the near future?
Yes
No
* Children at home?
Yes
No
If Yes, * Ages:
* Does anyone in your family have allergies?
Yes
No
If Yes to the above question, * please explain
* Do you have a local Veterinarian?
Yes
No
If Yes , * Vet's name, clinic, and phone number.
If you are not currently using a vet (don't have any pets), please
list the number and clinic of the LAST vet you used.
If Yes , * Enter the name which Vet Records can be found:
* What are your reasons for wanting a pet? Check all that apply:
Companion
Guard (Dog)
To Breed
Gift
For Child
Playmate for Current Pet
Replace Previous Pet
Other (please describe)
* Size Preference
Small
Medium
Large
No Preference
* Please specify the animal(s) from the website that you're interested in adopting:
Keep in mind the animal(s) you list may already
have several applications out on him/her or even an adoption
pending.
* How many hours a day will this pet be alone (without a human) ?
* Where will this pet be kept during the day (be specific) ?
* Where will this pet be kept at night (be specific) ?
* Is your yard fenced?
Yes
No
If your yard is fenced, * what type?
Chain Link
Wood
Iron
Other
If your yard if fenced, * what height is your fence?
3 ft.
4 ft.
5 ft.
6 ft.
* Are you a new pet owner?
Yes
No
* Are there other pets currently in your household?
Yes
No
* Is this your first adoption?
Yes
No
* Have you ever sold, given away or put a pet in the shelter? If yes, why?
No
Yes, because:
Please provide the following pet history for any pet you now own or have owned in the past 5 years.
* Do any cats in the household test positive for FIV or FeLV?
Yes
No
NA
* Are any of your cats declawed?
Yes
No
* Do you intend to declaw any future cats?
Yes
No
If Yes, * Explain:
If your animal(s) are not spayed and/or neutered, please explain why?
How did you hear about us?
Any additional comments you'd like to add about your application or anything else?:
This questionnaire will be reviewed by a PAWS representative. You may be asked
further questions in order to help match you with the best pet for your
household. PAWS reserves the right not to adopt any particular pet to any
particular home. Our goal is to make the best match between person(s) and
pet(s) to help assure a successful long-term (life) adoption. Thank you so
much for your interest in adopting one of our pets.