Have you ever been charged with a crime involving violence against an animal or human?
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Yes
No
I certify that I am 18 years of age.
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Yes
No
Name
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First Name
Last Name
Email Address
*
Phone number
*
Best way to contact you
Address (street, city, state, zip code)
*
Occupation
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Employer
*
Type of home you live in
*
House
Condo/Townhouse
Apartment
Trailer home
If you selected trailer home, please add the contact information for the mobile home park office.
Do you rent or own your home?
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Rent
Own
If you rent or are a roommte of the owner, please provide the landlord or owner's name and phone number..
If you do not own your home, do you have permission to have a dog?
Yes
No
Do you have a fenced-in back yard?
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List the name and number for a veterinary reference.
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Name under which veterinary records can be found.
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Number of people living in the home with you (count yourself):
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Number of people under the age of 18 living in the home:
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List the names, ages, and relationship to you of each individual under the age of 18.
Does anyone in the home have allergies?
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Yes
No
If there are allergies present, describe how they are being controlled.
Is everyone in the home in favor of adopting?
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Yes
No
If no, list the reason
Which dog are you interested in?
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If the dog you are interested in is no longer available, should we continue to process your application to be pre-approved for future cats?
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Yes
No
Are you aware of the financial obligations of owning a dog?
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Yes
No
Do you currently have pets?
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Yes
No
If yes, please describe the pets you currently have in your home.
*
Are your pets current on vaccinations?
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Yes
No
If no, please explain.
Are your pets spayed/neutered?
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Yes
No
If no, please explain.
Have you sold, given away, abandoned, or put to sleep a pet?
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Yes
No
If yes, please explain.
Has a pet ever disappeared, been killed, or mistreated while in your care?
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Yes
No
If yes, please explain.
Under what conditions would you give up a pet?
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Have you adopted a pet before?
*
Yes
No
Where will the dog be left while no one is home?
*
Who will care for your dog while you are on vacations or gone for an extended period of time?
*
Are you willing to work with the dog on the issues it may have?
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Yes
No
If you become unable to physically care for the dog, do you have an alternate caregiver?
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Yes
No
If yes, please specify the name and phone number of the alternate caregiver.
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Are you willing to allow Purrfect Pound Pals volunteer to do a home visit?
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Yes
No
Please add the name/address/email/phone number of a personal reference.
*
By checking this box, I certify I have answered all questions truthfully.
*
