Adoption Application                                                               Date: _________________

Name(s): ____________________________________________________________

Address: ____________________________________________________________

City: _________________________________ State:_______ Zip:_______________

Home Phone: ______________ Work Phone: ___________ Cell Phone: ___________

Name(s) of pet(s) you're interested in adopting: _______________________________

Why do you want to adopt an animal? ______________________________________

How long have you been looking for a pet? __________________________________

What is it about this animal that appeals to you? ______________________________

Are you aware of the financial obligation involved in having a pet? _________________

Are you aware that this animal will require routine vet care including (but not limited to)

annual examinations and vaccinations? _____________________________________

Do you agree to obtain required vaccinations? _______________________________

As an adult have you ever been a pet owner? ________________________________

Do you have any dogs and/or cats at home now? ______

1.  Age ____ Breed ____________ Sex _____ Licensed _____ Vaccinated ____

2.  Age ____ Breed ____________ Sex _____ Licensed _____ Vaccinated ____

3.  Age ____ Breed ____________ Sex _____ Licensed _____ Vaccinated ____

Name(s) of your pet(s):_________________________________________________

Approximate date and reason of last vet visit:________________________________

Have you had other pets in the past five years? ______________________________

1. Age _____ Breed ________ Year ______ Disposition _______
2. Age _____ Breed ________ Year ______ Disposition _______

              What happened to them? __________________________________

Do you: rent/lease_____ or own _____.

If you rent, is your lease monthly _____ or yearly _____.

Name of complex and/or association: ________________________________

PET POLICY: please attach a copy __________________________________

How long have you been at this address? _____________________________

If you had to move what would you do with your pet? _____________________

Do you intend to keep this animal inside, outside or both? ______________________

Do you have a fenced in yard? ___________________________________________

            If yes, please explain what type and is the whole yard fenced in?

Where will this animal sleep at night? _____________________________________

 How many hours per day on average will this animal be left alone? _______________

Where will this animal stay while you are gone? __________________________

Are you familiar with animal regulations in your city? _____________________

Are you willing to make a  commitment to provide for  this animal  for its entire life span? ______________________

If you are unable to keep this animal for any reason during its lifetime, we require that you contact Prairie Paws Rescue.

References

(a non-relative or vet reference is suggested)

Name: __________________________________ Phone: ____________________

Name: __________________________________ Phone: ____________________

 I, ________________________, understand that a home visit may be conducted prior to placement of this animal.

Signature(s): ________________________________________________________

Date: _______________________________________

Staff Signature: ______________________________________________________

Additional Comments:

Note To Applicant:  Please print this application, fill it in, and mail it to:

                               Prairie Paws Rescue,  P.O.Box 1114,  Jamestown, ND 58402-1114