Dog application

Adoption Application for Patriots for Pets Rescue and Shelter Inc.
Name of pet applying for. *
Full Name*

First NameLast Name
Your Age*
Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address *
How long have you lived at your current address? *
Do You Own or Rent. If you live with your parents and they are the homeowner please don't list that you own the home*
If "Other" than ownor rent - please explain in detail.
If you rent may we contact your landlord? If you answer no your application will not be approved. Contact with landlord is mandatory.
Landlord's Name

First NameLast Name
Landlord's Phone Number is mandatory if you rent

Area CodePhone Number
Landlord's E-mail address
example@example.com
If you have lived at current address less than 1 year - please give previous address AND length of time you lived there
Has anyone in your home ever been accused or convicted of animal abuse, child abuse or spousal abuse*
Ages and names of everyone residing in the home.*
If you do not list ages the application will not be reviewed
Is anyone in the household allergic to animals?

YesNoUnknown
Who will be primarily responsible for the care of this animal? *
Pet Information
Do you currently have any pets?*
Are all of these animals spay or neutered?*
If not, explain why:
Please list the breed of animal(s) and age(s) of the animals you currently have
Is your current animal(s) up to date on all shots? This will be verified.
Please list the type of pet(s) you have had in the past with breed, age, and gender as well as what happened to them that they are no longer with you
Where will this animal be for most of the day? *
Where will this animal sleep?*
On average, how many hours of the day will the animal be alone? *
Will the animal be allowed to be an indoor animal?*
Do you have a securely fenced yard?

Yes 3' or lowerYes: 4' to 5'Yes 6' or higherNo fence
If you don't have a fenced yard, please explain how you will exercise or contain this pet.
Are you aware of the leash laws? *
Are you aware of the rabies vaccination/licensing laws? *
Are you aware of the cost of maintaining a pet? *
Will you permit Patriots for Pets to do a home check prior to adoption? *
Have you ever surrendered an animal to the shelter or rescue or have you ever given a pet away that you no longer wanted or could not care for?*
If yes why?
Please list all of the situations in which you would surrender your pet to an animal shelter or give it away.*
Do you, or anyone in your household, have any depression or anxiety issues or any disabilities? If so please describe in detail the issues.
Do you have any physical Limitations?
If you have any physical limitations please describe fully what those are.
Why are you adopting this pet?*
If other please explain:
Veterinarian - if you do not have one please list who you anticipate taking your new pet to. If you have current or past pets a vet reference is mandatory.*
Phone Number - please provide this - if you don't we will not be able to complete the review on your application.*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
May we contact your veterinarian?*
How did you hear about Patriots for Pets?
Tell us about your life style, any life style changes in the near future that you think will affect the life of the pet or tell us any other information you would like us to consider when reviewing this application.
Please upload any photos such as your home, yard, or other pets that you would like to submit with your application
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I certify that all the statements and answers are true and complete. I am 18 years or older. I realize that any untrue statement will be deemed reason for refusal of adoption or reclaiming of any adopted pet. I also understand if I adopt an animal that adoption fees are non-refundable. Please type your full name(signature) *
Date and time of submission

MonthDayYearHourMinutesAM/PM Option
Should be Empty:

Adoption Application for Patriots for Pets Rescue and Shelter Inc.

Pet Information

Please upload any photos such as your home, yard, or other pets that you would like to submit with your application