Adoption Application Form - Pet Adoption Alternative of Warren (PAAW) - Pet Rescue Organization

Date and Time Form Completed:

Date

Time

Dog or Cat?

Dog
Cat

Name of Animal Applying for:

Animal Applying for if 1st choice is not available:

In the event the animal you are interested in is no longer available, would you like us to contact you in the future in regard to similar pets that become available?

Yes
No

Name: *

First

Last

Email: *

Phone: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Are you located more than 2 hours from Detroit, MI?

Yes
No

Are you over 18 years of age? If not, then you should not continue this application.

Yes
No

Have you ever owned a pet before?

Yes
No

What type of home do you live in?

Do you own or rent?

Own
Rent

Does your Association or Landlord allow pets?

Yes
No

If you rent, please upload a copy of your rental agreement showing you are allowed to have pets.

The following file types are accepted: .jpg, .png, .pdf, .doc, .docx

In the event that you are required to move in the future and cannot take the pet with you, please describe how you would handle the situation:

People in Your Household

How many people currently live in your household?

How many adults in household?

How many children in household?

If there are children in the household, please list the ages of the children.

Why do you plan on adopting a pet?

Family Companion
Companion for existing pet
Other

Does anyone in your household have allergies? If yes, please explain.

Are you aware that the cost of vet care is at least $100-$200 per year, without serious illness?

Yes
No

What happened to any previous pets you may have had? (i.e., passed away, ran away, gave to someone else)

Was your previous pet a...?

Family Pet as a Child
Roommate's Pet
N/A
Other

If other, please explain.

Where will this pet be living?

Inside
Outside
Both

Do you have a fenced yard? If so, what type of fence?

Chain Link Fence
Privacy Fence
Kennel

Approximately how many hours a day would the animal be left alone?

We might have someone from the rescue calling or coming to your home to check on the animal, is that okay?

Yes
No

Please list three personal references, with Phone Number and relationship to you. (No direct relatives please) *

NOTE: APPLICATIONS THAT DO NOT INCLUDE PERSONAL REFERENCES WILL NOT BE PROCESSED. PLEASE STOP HERE IF YOU ARE UNWILLING OR UNABLE TO LIST PERSONAL REFERENCES NOT RELATED TO YOU ON THIS APPLICATION.

Current Pets - Please supply information for all the pets currently living in your home. If no pets are currently living in your home, disregard this section and move to the next section.

Pet 1 - Name:

Pet 1 - Type (i.e., Dog, Cat):

Pet 1 - Age:

Pet 1 - Year Pet Adopted:

Pet 2 - Name:

Pet 2 - Type (i.e., Dog, Cat):

Pet 2 - Age:

Pet 2 - Year Pet Adopted:

Pet 3 - Name:

Pet 3 - Type (i.e., Dog, Cat):

Pet 3 - Age:

Pet 3 - Year Pet Adopted:

If you currently have more than 3 pets, please list them here. Show as: Name / Type / Age

Example: Name / Type / Age / Year Adopted

Are the animals Spayed/Neutered?

Yes
No

Are the animals currently on Vaccines?

Yes
No

Are the animals Declawed?

Yes
No

Are the animals on Heartworm Preventative?

Yes
No

Do the animals reside inside or outside?

Inside
Outside
Both

Current Pets - Please provide Veterinarian Information (Note: All Vet information will be verified).

Vet Name: *

City/Location:

Phone:

Please provide the name of the owner that the Vet records are under:

Are any of your pets being treated for medical conditions? Please explain.

Previous Pets - Please supply information for all the previous pets you have had for the last 10 years.

Pet 1 - Name:

Pet 1 - Type (i.e., Dog, Cat):

Pet 1 - Age:

Pet 2 - Name:

Pet 2 - Type (i.e., Dog, Cat):

Pet 2 - Age:

Pet 3 - Name:

Pet 3 - Type (i.e., Dog, Cat):

Pet 3 - Age:

If you have had more than 3 previous pets over the last 10 years, please list here. Show as: Name / Type / Age

Example: Name / Type / Age

Were these animals Spayed/Neutered?

Yes
No

Were these animals current on Vaccines?

Yes
No

Were these animals declawed?

Yes
No

Were these animals on Heartworm Preventative?

Yes
No

Did these animals reside inside or outside?

Inside
Outside
Both

Previous Pets - Please provide Veterinarian Information (Note: All Vet information will be verified).

Vet Name:

City/Location:

Phone:

Please provide the name of the owner that the Vet records are under:

Were any of your pets being treated for medical conditions? Please explain.

I understand completion of this evaluation does not guarantee the adoption of this pet. Furthermore, falsification of information will result in immediate denial of this application. Incomplete evaluation will not be processed.

Yes

How did you hear about us?

If approved, I would like to be contacted to set up a time to meet by:

Phone
Text
Email

If there is any other information you would like to make us aware of, please do so here.

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