Dog's Name
Your First Name
Your Last Name
Address
City
State
Zip Code
Phone # include area code(example...585-234-4790)
Work # include area code
How long have lived at this address?
Will you be moving soon? Select one Yes No
If moving, Where?
If you move what will you do with the dog?
What year were you born?
E-mail Address Occupation
Do you live in:
Suburban Single Double/Townhouse
Mobile/Trailer
City House Apartment
Country/Regional Home Studio
Village Home College Dorm
Do you: Rent Own
Whose name is the property listed in
Name of Landlord
Landlord's Phone # include area code
How many adults living in your home?
How many children living at home
Ages of children
Do any Grandchildren come over? How old?
Do you run a daycare in your home? Select one Yes No
Does anyone in your home have allergies? Select one Yes No What Kind?
Is this dog for:
Gift Companion Breeding
Family Pet Guard Dog Hunting
My other pet's companion
Another family member
Where will the dog be kept during the day?
In the house Outside Basement
Garage Crate Kennel
Chained Room
Where will the dog be kept during the Night?
Will the dog have the run of the house? Select one Yes No Only part of the house
Number of hours the dog will be left alone
How will you safeguard your new dog while you are away from home?
How will you housetrain and prevent destructive behavior while your new dog is home alone?
Who will care for your dog when you go on vacation or have an emergency?
Is your yard fenced adequately to keep your dog in and other dogs out? Select one Yes No
What type of fence Chain link Picket Stockade Barbed wire Invisible Fence Electric Kennel run
How tall is the fence? Select one 3 feet 4 feet 5 feet 6 feet 7 feet 8 feet
Does the gate close and latch securely? Select one Yes No
If you do not have adequate fencing how will you exersize the dog? Who will supervise these activities?
Have you ever owned a dog before? Select one Yes No If yes, when What kind of dog?
Have you ever lost a pet due to illness, old age, accident? Select one Yes No If yes, what happened to it? Old age Accident Ran away Illness Put to sleep What kind of pet was it?
Please List your Past Animals, How long did it live?
Have you ever had to give up a pet? Select one Yes No What kind of animal and Why ?
Have you ever brought an animal to the shelter? Select one Yes No If yes, what kind of animal and why ?
How many pets do you currently have living in your home? Select one None One Two Three Four Five Six Seven Eight Nine Ten More than ten
Please List Your Current Animals
Pets Owned: Breed
Age
How Long owned?
Male/Female
Are They Neutered/Spayed ?
Do these pets get along with other pets? Select one Yes No
Where did you get your pet(s)?
Name of Primary Veterinarian ( If you don't have a vet - type None)
Phone Number include area code
It may take new dogs several months to adjust to a new family and a new home. Are you willing and prepared to allow this much time for him/her to adjust? Select one Yes No
Are you willing to:
Use a crate? Select one Yes No
Take time to work with a dog? Select one Yes No
Have dog spayed/neutered if not already done? Select one Yes No
Walk dog on a leash? Select one Yes No
Go to obedience training? Select one Yes No
Housebreak the dog? Select one Yes No
Have a home check prior to or after adoption? Select one Yes No
Do you believe in having animals spayed or neutered? Select one Yes No
If your pet becomes lost or loose what would you do?
Why do you want this particular dog?
Are you aware of our policy that states you must contact us and return the dog to us if for any reason you cannot keep it? Select one Yes No
How did you hear about Paws n Claws ?
By pressing the submit button I acknowledge that all the information contained in this form is true and correct to the best of my knowledge. I understand that any misrepresentation of facts may result in the removal of the adopted pet from my home by Paws N Claws Animal Rescue. All information aquired in this form will be kept confidential and is the property of Paws N Claws Animal Rescue and will be used privately by Paws N Claws Animal Rescue in determining new homes for adoptable pets.
