NOTE: If You Fill out Your Application Online and Return It Electronically, Please Contact

NOTE: If you fill out your application online and return it electronically, please contact us at 708-990-0460 or if you have not heard from us in 48 hours to ensure your application has been received. Filling out an application does not guarantee adoption of one of our animals, but we do not adopt out any dog without this form completed and a contract signed.

Dog’s name: ______Breed/Mix: ______

CONTACT INFORMATION:

Your name ______

Address ______

Primary email address ______

Home number ______

Cell ______

Are you over the age of 21? ______Current Age: ______

Spouse/partner/roommate name ______Current Age: ______

Ages of children in your home or who visit regularly ______

Is everyone in your home in favor of this adoption? ______

Are you employed? (Where and for how long) ______

Work number ______

Do you rent or own? ______

Landlord’s name and number, if applicable ______

PET HISTORY INFORMATION:

If you currently have pets, or have ever owned pets, please complete the following:

Veterinarian______Phone ______Address ______

How many other pets do you currently own? ______

Dogs______Cats ______Avian/Reptile ______Other ______

Where did your current pets come from? ______

Have you ever had to give a pet away? ______

If yes, what were the circumstances? ______

Are your pets up to date on: Vaccinations______Heartworm prevention ______

Are your pets spayed/neutered? ______

If not, why? ______

If you have previously owned other pets, what happened to your last 3 pets? (List type, age, and circumstances for which you no longer own this pet)

Pet 1 ______

Pet 2 ______

Pet 3 ______

NEW PET ADOPTION QUESTIONS:

Are you familiar with the breed/mix of breeds of the dog you are interested in adopting?

If yes, please explain what you know______

______

Where will your new dog spend his/her time during the day? ______

______

Where will your new dog spend his/her time during the evening? ______

______

Where will your new pet spend his/her time when you are out town? ______

______

How long will your dog be alone, on average, without a potty break? ______

______

Do you own or plan to buy a crate? ______

If you don’t plan on crating, how will you keep your dog contained while you aren’t available to supervise

him/her? ______

Do you have a fenced in yard? ______

§  If yes, how high? ______

§  Is it fully or partially fenced? ______

§  Is it an electric fence? ______

§  Is it a wooden fence or chain link? ______

If you don’t have a fence, how will you keep your dog in close proximity? ______

______

Please list reasons why you would NOT keep a dog:

______

Please answer the following questions:

Are you willing to work on basic obedience, which may include going to obedience training?

______

What brand of food do you plan to feed your new dog?

______

In the event you become unable to care for this dog, who will care for him/her?

______

Are you prepared for the financial obligations of owning a dog, including but not limited to: food, shelter, obedience training, vet visits, medications and grooming?

______

Would you allow us to do a home inspection prior to adoption? ______

Do you understand that, even though vaccinated, we cannot guarantee the health or temperament of any dog adopted through our organization? ______

Do you understand that if you have children in your home, dogs and children must be supervised at all times? ______

Do you agree to care for this dog and provide food, water, medical care, grooming, indoor housing, and companionship for the rest of his/her life as long as you are capable? ______

Do you understand it is required by your contract to provide monthly flea/tick and heartworm prevention to your dog every month unless otherwise directed by your veterinarian? ______

Do you understand that this dog is a pet, and that if you cannot keep the dog you will immediately contact PAWS Illinois NFP to arrange for the dog to be picked up/dropped off at a specified location? ______

Do you understand if the dog must be returned and you cannot provide proof of current vaccinations and/or heartworm prevention, you will be charged a $25.00 owner surrender fee for the dog? ______

Do you understand it might take weeks to accept the dog back into foster care and that it is your responsibility to care for this dog until a foster home can be found? ______

Have you or anyone in your household been convicted of a crime against animals or children? ______

Relative Reference Name______Phone Number ______

Email Address ______

Non-Relative Reference Name______Phone Number ______

Email Address ______