__________ __________ __________
Date Name Tag
Perfect Pet Rescue, Inc.
10737 Venice Boulevard. Los Angeles, California 90034
Tel (310) 726-3731 or (310) 559-3770 Fax (310) 550-0121
ANIMAL ADOPTION APPLICATION
*** Completion of this application does not guarantee adoption of a Perfect Pet Rescue animal ***
Name of applicant ____________________________________________________ Occupation ________________________
Name of Spouse/Significant Other _______________________________________ Occupation ________________________
Names (and ages) of children, if any ________________________________________________________________________
Street Address _________________________________________ City ______________________ State ______ Zip _______
Home Phone ________________________ Work Phone __________________________ Cell Phone ___________________
Email Address__________________________________________________________________________________________
Emergency Contact - Name _________________________________ Best phone number to reach_______________________
Do you live in a House _______ Apartment ________ Condominium _______ Townhouse _______ Other ________________
Landlords Name and Phone Number ________________________________________________________________________
Do you Own _______ Rent _______ If you rent, do you have your landlords permission to have a pet? Yes _______ No _____
How much of the time will the dog be outdoors? ____________________ How much time indoors? _____________________
About what percent of the time will the dog be left alone without humans? __________________________________________
Where will the dog be when left alone? ______________________________________________________________________
What area(s) of the house will the dog be allowed into? _________________________________________________________
What area(s) of the house will the dog NOT be allowed into? ____________________________________________________
Where will the dog sleep at night? __________________________________________________________________________
Do you have a dog proof fenced yard? Yes _______ No _______ if yes, how high is the fence? _________________________
Type of fence? __________________________________________ Are the gate(s) normally locked? Yes _____ No ______
Do you have a doggy door? _______Yes _______ No
Do you have a pool? Yes _______ No ______ If yes, is it fenced separately from the yard? Yes ________ No ________
Why do you want a dog? (Check all that apply)
______ House pet ______ Companion for family ______ Companion for other pet
______ Companion for children ______ Protection for home/family ______ Protection for business
______ Watchdog ______ As a gift ______
______ Other (specify) ________________________________________________________________________
PPR ANIMAL ADOPTION APPLICATION - Page 1 of 2
Other pets (specify number of each): Dogs _____ Cats _____ Other ___________________________________________
If you have any dogs or cats, are they spayed/neutered? Yes _______ No _______
What pets have you had in the past? _________________________________________________________________________
What happened to the ones you no longer have? _______________________________________________________________
What would happen to the dog if you moved:
Locally? _______________________________________________________________________________________
Out of state? ____________________________________________________________________________________
Out of the country? _______________________________________________________________________________
Where would the dog go when you go for vacation? ____________________________________________________________
Do you have a regular veterinarian? Yes ________ No ________
If yes, vets name __________________________________ Name of Clinic _________________________________
Address _________________________________________________ Phone _________________________________
Does anyone in your household have allergies: Yes ________ No ________ What kind? _______________________________
How would you train this dog? (Check all that apply)
_______ Obedience school _______ Hit with newspaper _______ Choke collar
_______ Firm verbal commands _______ Clicker/hand signals _______ Positive Reinforcement
Other (specify) __________________________________________________________________________________
How and how often do you plan to exercise your dog? __________________________________________________________
Will you be committed to potty train if needed? Yes _______ No _______
Will you be able to live with hair on your furniture, stains on your rugs, a warm body on your bed, and an animal that might be
destructive at time? Yes _______ No _______
Remember, pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet,
proper shelter and exercise for your new pet? Yes _______ No _______
If your dog were injured or ill, are you committed to take him/her to the vet? Yes _______ No _______
Are you able to make a long term commitment to care for this dog for its entire lifespan, which could be as much as 10-20
years? Yes _______ No _______
Under what circumstances would you not be able to keep this dog? ________________________________________________
Signature __________________________________________________ Date ______________________________________
Perfect Pet Rescue, Inc. reserves the right to refuse adoption to any Client for any reason.
This questionnaire becomes part of our contract.
PPR ANIMAL ADOPTION APPLICATION - Page 2 of 2
