Adoption Questionnaire

Paws Crossed Animal Rescue Inc - Adoption Application

Healing hearts one paw at a time.
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Post codeCountry
E-mail
Phone Number*

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

MonthDayYear
Residence*

House, ownHouse, rentUnit, OwnUnit, Rentacreage/ PropertyOther
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.

Is anyone in your home allergic to animals?*

YesNo
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 puppymedium to large breed dog or puppylarge to giant breed dog or puppyWorking breed.Other
Name of specific animal you're interested in (if any):
Age of pet wanted*

Young Puppy 2-4 months oldAdult (1-7)Junior Puppy 5 month - 1 year oldSenior (7 +)No PreferenceOther
I prefer a *

MaleFemaleNo preference
This animal needs to get along with:*

DogsCatsKids under 5Kids over 5MenWomenOther animals not listed
This animal will be*

Companion for myself /My householdGift for extended familyGift for someone outside familyBusiness tax deduction - property protection or working dogOther
I prefer an animal with an activity level that is:*

LowMediumHighNo 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.*

Paws Crossed Animal Rescue Inc - Adoption Application