PWP logoPETS WITHOUT PARENTS ADOPTION APPLICATION


INSTRUCTIONS


YOU MUST BE AT LEAST 18 YEARS OF AGE TO COMPLETE AND SUMBIT THIS APPLICATION.
YOU MAY NOT COMPLETE THIS APPLICATION FOR ANYONE OTHER THAN YOURSELF.

I certify that I am at least 18 years old AND that I am completing this application for myself.

PET INTERESTED IN  

Pet's Name:          Is this a Cat or Dog?:CatDog 


Pet's Breed:           Sex of pet:FemaleMale        Age of pet: 



APPLICANT INFORMATION  

Applicant's Name: 


Address: 


City:  State:   Zip Code:  County: 


Home Phone:   Cell Phone:  Work Phone: 


Place of Employment:     Occupation:   Are you a student?: YesNo


E-mail address:     


REFERENCES (only one may be a relative):
Name:    Phone:   Relationship:
Name:    Phone:   Relationship:


Where do you live?

Apartment/Townhouse/Condo
House/Duplex
Live with Parents
Other: 

Do you own or rent your home? Own Rent

If you rent, please provide your landlord's contact information:
  Phone:


# of Adults at home:  # Children at home and ages: 

Has anyone in the home been convicted or charged of a crime related to violence?: YesNo

Have you ever filled out an adoption application with Pets Without Parents?: YesNo

Have you ever adopted from Pets Without Parents?: YesNo

How did you find out about Pets Without Parents?: 



HISTORY OF PET OWNERSHIP  

Please list your current pets:

1.) Name:     Type: Cat Dog    Breed:      Age: 
Spay or Neutered? Yes  No   How long have you had this pet?:     Current on Vaccinations?: Yes  No

2.) Name:      Type: Cat Dog    Breed:      Age: 
Spay or Neutered? Yes  No   How long have you had this pet?:     Current on Vaccinations?: Yes  No

3.) Name:      Type: Cat Dog    Breed:      Age: 
Spay or Neutered? Yes  No   How long have you had this pet?:     Current on Vaccinations?: Yes  No

4.) Name:      Type: Cat Dog    Breed:      Age: 
Spay or Neutered? Yes  No   How long have you had this pet?:     Current on Vaccinations?: Yes  No

(If you have additional pets, please list them in the "comments" field at the end of this form.)


Where are these pets kept during the day?:    At night?: 

Please list previous pets that you've owned in the last five years (not including your current pets):

1.) Name:  Type: Dog Cat
When and why did the relationship end? 

2.) Name:  Type: Dog Cat
When and why did the relationship end? 

3.) Name:  Type: Dog Cat
When and why did the relationship end? 

4.) Name:  Type: Dog Cat
When and why did the relationship end? 

(If you've had additional pets, please list them in the "comments" field at the end of this form.)


Have you ever given up a pet? Yes No     If yes, what were the circumstances? 

Why would you NOT keep a pet? (check all that apply):
Allergies
Moving
Marriage
Divorce
Too Expensive
New Baby
Illness of pet
Illness in family
Gets too big
New job
Animal's Behavior
Not getting along w/current pets
Lack of knowledge
Not enough time
I would never give up my pet
Other Reasons 


Your Current or Previous Veterinarian:   Phone: 

If you've used a previous vet, or your pet records are under a different name than yours (spouse, parent, etc), please provide that information in the Comments field below.


CARE OF YOUR NEW PET  

Why do you want a pet? (select all that apply)

Companion
Gift
Watch Dog
To Breed
Mouser
Child's Pet
Friend for Other Pet
Other 

Do you intend to breed this pet? Yes No

Do you have a fenced yard? Yes No

Do you own a crate? Yes No

Where will your new pet stay during the day?  

How long will your new pet be alone during the day (# hours)? 

Where will your new pet sleep at night?

Per year, how much do you expect veterinary costs to be?:  
Can you/will you afford an average of $500 in vet expenses should this pet become ill?:  Yes No

Do you anticipate any major changes in the next year (moving, new baby, etc.)? Yes No
    If yes, please describe: 

Your new pet could live for another 20 years. Do you understand the responsibility involved, and are you willing to make a lifelong commitment to this pet?
Yes No

IF ADOPTING A CAT:

How will you prevent your new cat from scratching furniture, etc?: 
Will you let your new cat outside, and under what circumstances?: 
Do you intend to declaw your cat?: Yes No

IF ADOPTING A DOG:

How will you deal with behavioral issues that may arise with your new dog?:   Do you expect your new dog to have accidents in the house, even if it's housebroken?: Yes No


ADDITIONAL COMMENTS  

 

AFFIRMATION  

Pets Without Parents, Columbus relies on the information given above to be complete and accurate in order to act on your application in a timely manner. Any false statements, misrepresentations, inaccurate information, or failure to supply the data requested may serve as a rejection of your application. By selecting "I Agree", you are authorizing the use of any screening agencies to verify criminal history and vaildate the accuracy of all information recorded above, and you give Pets Without Parents, Columbus the right to call your references, landlord, and veterinarian. I also understand that this application will not be fully approved until I have come in to meet the pet and been interviewed by Pets Without Parents staff. Pets Without Parents, Columbus reserves the right to reject any application for any reason.


I Agree I Disagree     Date:  


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