Name

Address    City     State      Zip

Home phone          Work phone        Email

Why are you considering adoption now?

Does everyone in household (if more than one adult) want a new pet? Yes           No           N/A

Type of residence:    House       Apartment        Mobile Home      Other
Do you: Own         Rent
If rental, are cats and dogs allowed? Yes       No

How many adults in your household?     How many children?     
Ages of the children?

Does anyone in your household have allergies to animals? Yes           No

How many hours per day will the pet be alone?
Where will the pet stay when left alone?

Are you willing to allow a routine home visit prior to adoption? Yes       No

If adopting a dog, do you have a fenced yard? Yes       No           A pet door? Yes       No
What kind of accomodations will you have for your pet during cold weather?

Many pets lose their homes because people move. Would you move someplace you couldn't take your pets? Yes       No

Are you presently Employed        Unemployed         Retired        Student
If employed, please list employer:

Have you ever had to give up a pet or turn one in to animal control? Yes       No
If so, what were the reasons?

In case you experience a life change (for example, a move, a divorce, a new baby), how will this affect the animal?

Are you going to allow the cat outdoors? Yes       No
If so, why do you think the cat will be safe?

If this cat climbs on things, claws the furniture, develops a problem using the litter box, or has an attitude, what will you do about it?

DOGS ONLY:
How many hours will this dog be outside?
Would this dog be allowed inside the house? Yes       No
If no, why not?

Would you ever leave this dog tied up outside? Yes       No
If yes, please explain:

How will you deal with any "accidents" or other behavior (digging holes, barking, etc.) that the dog might have?

What type of training will you use?

Please list the pets that you have had in the past five years:

Please list 2 personal references that are not relatives.

Name of current vet (if applicable)              Phone #:
Any other comments?

I grant Phelps County Animal Welfare League permission to contact the references above as well as my veterinarian for access to all existing pet medical records.

If, for any reason or at any time, I am unable to care for my adopted pet, I agree to return my adopted pet to PCAWL; I further agree never to abandon my adopted pet or release my adopted pet to an animal shelter or research facility.  However, before relinquishing my adopted pet back, I agree to exhaust all options available to me, including, but not limited to, a behaviorist, or veterinary advice to solve any physical or behavioral problem that may occur.

I agree that by accepting my pet for adoption, I am accepting responsibility for the animal.  I understand this means that Phelps County Animal Welfare League is not responsible for any damage to person or property that may be caused by my adopted pet after the date of adoption and I accept full responsibility for my adopted pet from the date of the adoption forward.

I hereby declare that the above information is true and correct to the best of my knowledge.

If you have any questions, please email us. Thank you for your interest in adopting a rescued pet and saving a life.