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? _____________________________________

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? ____________________________________

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