Adoption Application

Please take a moment to tell us a little about yourself so that we can help you make the best match possible.

Name *
Address *
Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone
Email *
Email (again for verification) *
Home Information
Do you rent or own your home?
Own Rent
If you rent, please provide the name, email, and phone number of your landlord
Are you over 21?
Yes No
Are you employed?
Yes No
How many adults reside in your home?
Please list the ages of each child in your home:
On a typical day, how long will this dog or puppy be alone?
Where will he/she be left when you are not there?
Is your yard entirely and securely fenced?
Yes No
If your yard is not fenced, have you considered a safe way to confine the dog when you are outside?
Would you still be able to care for this dog if your home or family situation changed (divorce, relocation, baby)?
Yes No Unsure
Please explain your answer above:
Other Pets
Do you currently own any other pets?
Yes No
If so, are they all spayed / neutered and medically up to date?
Yes No
If not, why?
List names, breed, age and sex of each of your current pets (cats, dogs, etc.):
What happened to the last pet(s) in your care?
What are you looking for?
Did you see a particular dog or puppy(s) on the website that interested you? Who:
How would you describe your lifestyle?
Homebody Active Outdoors Running the children from event to event Have lots of visitors Workaholic Hardly ever home
Other / more details:
What are your preferences for activity level?
Atheltic / high energy Lap dog Mellow Affectionate Active outdoors
Other / more detail:
What are your preferences for age and sex?
Baby Young Adult Adult Senior Male Female
Please tell us about your family and dog experience:
What circumstances would be cause for you to surrender your dog? Please be specific:
Are you aware that most shelter animals have unknown backgrounds and that while we do our best to guess at breed/ age/ temperament we can not be sure of these items?
Yes No
Are you aware of the time and financial commitment a dog will require (obedience classes, supplies, vet bills, food, dog walkers/sitters etc?
Yes No
What do you estimate to be the annual cost of owning a pet (not including emergencies)?
Previous Adoptions
Have you ever adopted from a Humane Society / Rescue before?
Yes No
If so, how long ago?
Have you ever surrendered an animal you owned to a Humane Society?
Yes No
If yes, what were the circumstances?
ReferencesPlease provide the name and number of a reference. If you have/had pets, please list your current veterinarian.
VetName and phone number
ReferenceName and phone number
Other Information

I understand that the adoption fee of $400 consists of some / all of the following medical care:
Health examination(s)
Spaying/Neutering
30 days of FREE Pet Health Insurance
Wormings (age related)
Distemper Combo Vaccination(s)
Rabies Vaccination (If older than 4 months when adopted)
Heartworm Disease Test (If older than 6 months when adopted)
Flea & Tick Treatment
In addition, most (not all) of our animals are microchipped and we provide FREE registration through 24 Hour Pet Watch
I agree to the $400 adoption fee
Yes
Is there any additional information you would like us to know or questions you need answered?
Thank you!IMPORTANT: When you hit "Send to PawSafe", you will get an instant email back with more information about adoption. If you do not receive this, you email address was not entered correctly or our email has gone to your spam folder. In order for us to respond to your application, please ensure this email arrives within 15 minutes.
[Please note: PawSafe is a small rescue run entirely by volunteers. We try our best to get back to you quickly, but it may take several days. We appreciate your patience! If you have some extra time and would like to volunteer to help screen families, please let us know - we'd love the help.]

Verification

Please enter any two digits with no spaces (Example: 12)*