Adoption Questionnaire

Paws Crossed Animal Rescue Inc - Adoption Application

Healing hearts one paw at a time.
Full Name *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Post code Country
E-mail
Phone Number *

phone number
Have you ever given away a pet before for any reason? please explain
Birth Date *

Month Day Year
Residence *

House, own House, rent Unit, Own Unit, Rent acreage/ Property
How long have you lived at you current residence?
How long to you plan to stay at this residence? *
If you do move in the future, what are your plans for your animals? *

List all other people living in your home.

Name

Age

Gender

Is anyone in your home allergic to animals? *

Yes No
Name of your veterinarian or veterianry Hospital/Clinic: *
Phone number of your veterinarian: *

phone number
The animal you are interested in:
I want to adopt a *

Small breed dog or puppy medium to large breed dog or puppy large to giant breed dog or puppy Working breed.
Name of specific animal you're interested in (if any):
Age of pet wanted *

Young Puppy 2-4 months old Adult (1-7) Junior Puppy 5 month - 1 year old Senior (7 +) No Preference
I prefer a *

Male Female No preference
This animal needs to get along with: *

Dogs Cats Kids under 5 Kids over 5 Men Women Other animals not listed
This animal will be *

Companion for myself /My household Gift for extended family Gift for someone outside family Business tax deduction - property protection or working dog
I prefer an animal with an activity level that is: *

Low Medium High No Preference
What type of personality are you hoping for in your new pet?
What concerns , if any do you have regarding adopting this animal?
Will your pet spend any time outside? How much? *
What food or foods do you anticipate feeding your new pet. (Suggestions available) *
Are there any behaviors this animal could have that would be totally unacceptable to you?

Please tell us about the animals you have now. *

Name

Species

Male or Female?

Spayed or Neutered?

Age

Notes:

Paws Crossed Animal Rescue Inc - Adoption Application