P I T T E R P A T T E R
A N I M A L R E S C U E, I N C.
Pitter Patter Animal Rescue, Inc
Adoption Application- 2016
To help insure the best possible placement of our rescued animals, and in order to determine that the proposed adoption is in the best interest of the animal for you and your family: Please complete each of the following questions. Please be as thorough as possible. Applicants must be 21 or over. Adoption approval status is based on the review of your complete application, reference checks, and applicant interview via telephone and/or home visit. Applications that are not completed will not be reviewed or considered for approval.
Type of Animal You Wish to Adopt:
Name of Animal:
Name: ______Spouse’s Name:______
Address:______
City/State/Zip: ______
Home Phone:______Work:______Cell:______
Email Address:______
Place of Employment: ______
Household Information
1. Do you live in:
a: House
b: Apartment
c: Condo
d: Mobile Home
2. Do you:
a: Own
b: Rent
c: Live with parents/guardians
3. If you are a renter, does your lease state that pets are allowed? Any restrictions to breed or size?
a: Yes
b: No
Landlords name & phone #, and or attachment of proof.
______
4. Length of time at current residence?
a: 1-3 years
b: 3-5 years
c: 5+years
If less than 1 year, please provide previous address and length of time at that residence:
a: 1-3 years
b: 3-5 years
c: 5+years
5. If you are planning on adopting a dog, do you have a fenced-in yard?
a: Yes
b: No
What type of fence (chain link, stockade, etc.)?
If you do not have a fenced yard, what arrangements do you plan to make for exercise and toilet duties:
6. Number of adults in home:
Age of adults:
7. Number of children in home:
Age of children:
8. Have allergies to animals been a problem to any household member?
a: Yes
b: No
If yes, how? ______
9. Are all family members aware that you are considering adopting a pet?
a: Yes
b: No
Do they all approve?
a: Yes
b: No
Pet History
1. Do you own other pets?
a: Yes
b: No
Total number of animals:
2. Are/were they current on their vaccinations (deceased, past and present)?
a: Yes
b: No
3. Are/were your dogs on Heartworm preventatives (deceased, past and present)?
a: Yes
b: No
Do/did your cats go outside (deceased, past and present)?
a: Yes
b: No
4. Please complete the following information for each pet (passed and present):
Name: Name:
Type/Breed: Type/Breed:
Sex: Male/Female Sex: Male/Female
Age: Age:
Neutered/Spayed? Yes/No Neutered/Spayed? Yes/No
Length of ownership: Length of ownership:
Name: Name:
Type/Breed: Type/Breed:
Sex: Male/Female Sex: Male/Female
Age: Age:
Neutered/Spayed? Yes/No Neutered/Spayed? Yes/No
Length of ownership: Length of ownership:
5. Have you had other pets in the last five years?
What happened to them?
______
6. Have you ever applied or adopted a pet from an Animal Shelter, Pound or Rescue before?
If so, which one, applied or adopted?
______
7. Have you ever given up a pet for adoption or surrendered an animal to an Animal Shelter, Pound or Rescue?
a: Yes
b: No
If yes, please explain the circumstances:
______
Pet Care Information
1. Will there be someone home with your pet during the day?
a: Yes
b: No
2. What is the greatest number of hours the pet will spend alone daily/nightly?
Daytime Hrs alone: Evening Hrs alone:
3. Where will the pet spend most of its time?
a. Crate
b. Indoors
c. Outdoors
d. Garage
e. Basement
f. Run
4. Where will your new pets main sleeping quarters be?
a. Crate
b. Pet Bed
c. Share bed with owner
d. Designated Room
e. Outdoors
f. Garage
g. Basement
5. If adopting a puppy or dog, would you consider hiring a pet walker, pet sitter, have a neighbor or family member visit, or enrolling your dog in a Doggy Daycare on your long work days? Will you attend training class? Will you attend socialization classes? Explain the circumstances:
a: Yes
b: No
6. Do you plan to travel/vacation with your pet?
a: Yes
b: No
7. If not, where will the pet stay while you are away?
a: Friend or Family
b: Kenneled
c: In home pet-sitting
8. Have you ever taken a dog to obedience class/training class/socialization class?
a: Yes
b: No
9. Have you ever crate trained a dog?
a: Yes
b: No
10. What types of activities do you plan for you and your dog?
______
11. How much do you think this pet will cost you each year (please include food, heart worm preventative, flea control, medical and dental care, supplies, training, grooming, training, boarding costs, toys, training?
______
Desired Animal
1. What type of animal are you looking for? Name or breed?
______
2. What sex animal are you looking for?
a: Male
b: Female
c: No preference
3. What age animal are you looking for?
a: Baby
b: Young
c: Adult
d: Senior
4. Would you accept an animal that has a treatable (curable, temporary or longterm) medical condition? Please explain.
a: Yes
b: No
______
______
5. Why do you wish to adopt this type of animal?
a. Family member
b. Companion
c. Breeding - Watchdog
d. As a gift for someone
e. Other: (explain)
______
6. If interested in a cat, are you planning to de-claw him/her?
Are you planning to let the cat go outside? yes no
Would you allow a Rescue Representative to do a home visit? yes no
References: Please call ahead to your Veterinarian's Office to make available & release your pet/s information to Pitter Patter Animal Rescue, Inc.
1. Name of current veterinarian (this is to be completed even if animal deceased or past):
Clinic/Vet:______
Address:______
Telephone #:______
Name & date/s of Pets treated at this facility:______
3. List 2 non-relative personal references:
Name______Name______
Address______Address______
Phone ______Phone______
Relation______Relation______
Post Adoption Requirements
- If you adopt a puppy or a kitten that is to young or does not weigh enough to be sterilized a voucher is given to you or a representative will provide transportation for the procedure.
- Your adopted pet will live indoors with respect of a family member and not left restrained unsupervised outside.
- If adopting a dog, you will abide by your Town’s leash law.
- You will notify Pitter Patter Animal Rescue, Inc., if you feel you cannot keep your adopted pet: You must not sell the animal or give it to anyone else.
- You are responsible for providing proper shelter, food, water, exercise, medical care, training, and humane treatment at all times for your companion animal.
- You will adhere & abide by all terms of Pitter Patter Animal, Inc., Adoption Contract & Post Adoption Requirements.
“I certify that by submitting the information given on this application all entries are true and correct. If I am approved by Pitter Patter Animal Rescue, Inc., to adopt an animal, I agree to all the above requirements. I understand that failure to comply with any of the requirements will result in the return of adopted animal to PPAR.” Pitter Patter Animal Rescue has the right to refuse any placement.
Signature of Applicant: ______Date: ______
*Returning this form by email, your name in the signature line is your electronic signature.
Thank you for your interest in a rescue pet and for filling out this Adoption Application. Should the pet you are applying for have an adoption pending before you, you may use this application when you see another available animal that you are interested in. Pitter Patter Animal Rescue, Inc., is committed to helping you with a future pet match for you and your family.
Sincerely,
Pitter Patter Animal Rescue, Inc.
220 Lake Street
Silver Lake, Wisconsin 53170
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