PALMETTO PAWS ADOPTEE APPLICATION FORM
Thank you for your interest. All information you supply is confidential. Completion
of this form does not guarantee that you will receive an animal from us. All of this
information will be used to determine if we have a suitable animal available
for your desires and lifestyle. Our goal is to match the right animal with the
right home. Incomplete applications will not be considered.
PLEASE RETURN TO PALMETTO PAWS:
palmpaws@yahoo.com
Date: _________________________
Name: __________________________________
Street Address (no PO Boxes):___________________________
City: _________________________ State:_____________ Zip:_______________
Home Phone ( _____)_____________
Work (_____)_______________
Cell (_____ )____________
E-mail:_______________________________
Which dog/cat are you interested in?________________________
Are you?
Married Single
If Married, Spouses Name:__________________
What is your occupation? _____________________
What is the occupation of your spouse?________________
Please list ages of all the people living in your
house:__________________________________
Where do you live:
Do you
House
Apartment
Condo
Mobile Home
own or rent?
If you rent, please provide landlords name and #:__________________________________
Who will be responsible for the welfare of the dog?_________________________________
Why are you interested in adopting a dog?_______________________________________
Do you prefer a male or female? Why?____________________________________________
Are you interested in a puppy or older dog? Why?___________________________
Are you committed to caring for this dog for its lifetime?___________________________
Are you willing to deal with health issues should the dog have them later in life?
_________
How much time will the dog be left alone?____________
Where will the dog stay during the day?_____________________
Where will the dog sleep?__________________________
Are you familiar with crate-training?_____________________
Do you have a fenced yard?________Type of fence?_______Height of fence?____________
Do you plan to chain, tether or put the dog on an overhead runner?
________________________
Other pets currently owned
Name:___________Breed:___________Sex:______Age:______Spayed/Neutered?_______
Name:___________Breed:___________Sex:______Age:______Spayed/Neutered?_______
Name:___________Breed:___________Sex:______Age:______Spayed/Neutered?_______
Name:___________Breed:___________Sex:______Age:______Spayed/Neutered?_______
List ALL other previously owned pets in the last 10 years and reason you no longer
have them
Name:___________Breed:______________Reason:____________________
Name:___________Breed:______________Reason:____________________
Name:___________Breed:______________Reason:____________________
Name:___________Breed:______________Reason:____________________
no NA
If you have dogs are they current on heartworm prevention? yes no
Are all of your current pets up to date on vaccines:
yes
NA
Please tell us what you know about heartworm disease:_____________________________
_________________________________________________________________________
Name of current or prior veterinarian:
Name of Veterinarians Office:______________________________
Address________________________________________________
Phone (________)________________________
How do you correct unwanted behaviors in a dog, please give an example?
_________________________________________________________________________
Have you ever taken a dog to obedience classes?__________Where?
_____________________
Are you willing to attend obedience class:
yes
no
Are you willing to allow a rescue member to visit your home by appointment?
__________
Please add any other information you wish us to consider for possible placement of a
dog with
you:__________________________________________________________________________________
_____________________________________________________________________
I declare that the above is true to the best of my knowledge and ability. I authorize
the Veterinarian listed above to release medical information of my current or prior
pets. I understand that the completion of this form does not guarantee my receipt of
an animal.
___________________________________________
Signature
