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Pre-Adoption Application Date: ______________________ Name(s): _________________________________________________________________ Address: _________________________________________________________________ City: ___________________________________ State:_______ Zip:__________________ Home Phone: ______________ Work Phone: ______________ Cell Phone: _____________ Email:____________________________________________________________________ Place of employment?________________________________________________________
Animal you are 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? ____________________________________
Who will be the primary care giver for this pet?______________________________________
Have you adopted from any other rescue or shelter in the past?_________________________
Number of people in your family (including children under 18 and ages)___________________
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:______________________________________
Are your pets spayed or neutered?______________________________________________
Have you had other pets in the past five years? _____________________________________
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? ____________________________________ Name of Landlord and phone number:______________________________________________________________ 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?_____
Do you have a history of human or animal abuse or been convicted of a crime against either? ______ If yes, please explain: _________________________________________________
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 submit it to: Prairie Paws Rescue, P.O.Box 1114, Jamestown, ND 58402-1114
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