Home #: Work #:Other:
E-Mail address:
Occupation : Company Name:
What type of animal are you looking for (check all that apply):
Companion House Pet Outdoor
PetGuard Dog Gift
If this pet is for a gift, for who?
Does person know they are getting a pet as a gift?
Do you currently own any pets? If Yes, please list below:
1) Species Male/Female Spayed/Neutered
Inside/Outside Pet? Age Years Owned
2) Species Male/Female Spayed/Neutered
Inside/Outside Pet? Age Years Owned
3) Species Male/Female Spayed/Neutered
Inside/Outside Pet? Age Years Owned
Who is your Veterinarian/Clinic?
May we call your vet as a reference?
If you have not had a vet in the past 3 years, who do you intend to use?
List all animals you have owned in the past 5 years:
1) Species Male/Female Spayed/Neutered
Where did you get it?
Years Owned
What happened to this animal?
2) Species Male/Female Spayed/Neutered
Where did you get it?
Years Owned
What happened to this animal?
3) Species Male/Female Spayed/Neutered
Where did you get it?
Years Owned
What happened to this animal?
During the past 5 years, how many litters of puppies or kittens were produced by
animals you owned or maintained?
How many of these litters were intentional on your part?
What happened to them?
Do you Rent Own Apt House Condo Duplex Mobile/Court
If renting, are pets allowed? Landlord/Bulding name
Landlord phone number
Does everyone in your household want and agree to adopt this pet?
If not, who does not?
Do you have a fenced yard? How high is your fence?
What type?
Chain wall?
If you do not have a fence please explain how you will handle your dog or puppy's
bathroom & exercise?
How do you feel about pets being spayed or neutered?
Have you ever had a dog diagnosed with Heartworm Diesase?
Do you know about heartworm preventative?
Will you use Heartworm Prevention?
What kind of Heartworm Pevention will you use?
Will anyone be home during the day? If so who?
Please list ages of children living in the home.
Puppies need special attention. If you are adopting a puppy into a home with
young children, what special attention will you provide?
Does anyone in your household have allergies to animals?
Kind of pet allergy?
Do you travel often? If yes, how often?
How will this animal be cared for if you are gone for a week or more?
Are you planning to move? If yes, what will happen to this pet?
Have you ever taken an animal to a shelter/pound?
If so, where and why?
What circumstances would cause you to give up this pet?
How will you keep this dog on your property?
How many hours a day do you have to spend with this/train this animal (don't count
sleeping hours)
Have you ever taken your puppy/dog to Obedience Training?
Are you willing to take this puppy/dog to Obedience Training?
Have you ever Crate Trained a puppy/dog?
Are you willing to Crate Train you new puppy/dog?
How will you house train this puppy/dog?
Dogs can dig, chew, bark, jump up on people and bite. How do you plan to deal
with these or any other potential problems?
How much of the 24 hour day will this animal be kept inside?
Where will this animal stay at night?
Are you aware that some doges live an average of 15 years or longer, while others live
8 years or less?
Are you aware that dogs need regular vaccinations and may require other routine
veterinary care?
Are you willing to provide adequate medical care if this dog should become sick or
injured?
A member of P.A.W.S. may visit your home (with an appointment)
after adoption. Is that o.k.?
List two reference unrelated to you, one perferably a veterinarian (name/title/phone
number)
In which ways did you hear about Plaquemines Animal Welfare Society having animals available
for Adoption? Newspaper Plaquemines Animal Welfare Society Website PETFINDER FriendPETsMART Veterinarian (name)