PAWS Ohio DOG/PUPPY ADOPTION FORM

items marked with a * are required fields

Is there a specific dog that you are interested in?
If yes, dog's name:
ABOUT YOU~
Your Name Your Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
County
Email
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####
Birth Date Birth Date / MM / DD YYYY
Age
Maximum of 2 digits allowed. Currently Entered: 0 digits.
Do you own or rent your home?
Landlord's Name

If not applicable, type in N/A
Landlord's Phone Landlord's Phone - ### - ### ####

required if you rent
What is your home's type?
How many years have you lived at this address?:
Where did you live before?
Do you have any children under the age of 5?
How did you hear about us?
Why do you want to adopt a dog/puppy?
When did you decide to get a dog/puppy?
Who do you live with?

Who do you live with? spouse children parents significant other roommate(s) I live alone
Number of adults in household?
Number of children in household?

If not applicable, type in N/A
Ages of adults in household
Ages of children in household

If not applicable, type in N/A
Are you or any family members allergic to pets?:

Are you or any family members allergic to pets?:
cats only dogs only both cats and dogs no
Age Preference:

Age Preference: puppy senior adult no preference
Personality traits you would like in a dog/puppy:

Personality traits you would like in a dog/puppy: playful will hunt mellow good with kids energetic easily trained fully trained athletic protective loves to spend time outdoors other other
Size preference

Size preference small medium large no preference
Do you have a completely fenced in yard?

Do you have a completely fenced in yard? yes no
What type of fence do you have?

What type of fence do you have? privacy fence chain link electric n/a other other
PREVIOUS PETS~

Please tell us about the pets you have now and have had in the past
Previous pet's name:
Spay/Neutered?

Spay/Neutered? yes no
Area:

Area: indoor outdoor both
Deceased?

Deceased? yes no
Cause of death:
Previous pet's name:
Spay/Neutered?

Spay/Neutered? yes no
Area:

Area: indoor outdoor both
Deceased?

Deceased? yes no
Cause of death:
Previous pet's name:
Spay/Neutered?

Spay/Neutered? yes no
Area:

Area: indoor outdoor both
Deceased?

Deceased? yes no
Cause of death:
Previous pet's name:
Spay/Neutered?

Spay/Neutered? yes no
Area:

Area: indoor outdoor both
Deceased?

Deceased? yes no
Cause of death:
Veterinarian's name:

If not applicable, enter N/A
Veterinarian's phone Veterinarian's phone - ### - ### ####
Do you give us permission to contact your Veterinarian?

Do you give us permission to contact your Veterinarian? yes no
WHO WILL BE PRIMARILY RESPONSIBLE FOR CARE?:
Name Name First Last
Age
How do they feel about getting a dog?
WHO ELSE WILL BE RESPONSIBLE FOR CARE?:
Name: Name: First Last
Age
How do they feel about getting a dog?
Name: Name: First Last
Age
How do they feel about getting a dog?
What type of lifestyle do you want your dog to live?

What type of lifestyle do you want your dog to live? indoor outdoor both indoor and outdoor
Where will your dog stay while you are at work?
Where will your dog sleep?
What are your plans for the dog when you go away on vacation?:
How long do you expect a dog to live?:
Is this pet for you or a third party?

Is this pet for you or a third party? for myself/ my family to give away as a gift
Can a PAWS adoption volunteer make a follow-up visit ?

Can a PAWS adoption volunteer make a follow-up visit ? yes no
Check any of the following reasons you would give your dog away.

Check any of the following reasons you would give your dog away. too expensive fleas sheds too much allergies getting married/divorced children will no longer take care of it new living arrangements don't allow pets having accidents in the house none of the above Other Other
Personal references

please list 3
Name Name First Last
Phone Phone - ### - ### ####
Relationship
Name Name First Last
Phone Phone - ### - ### ####
Relationship
Name Name First Last
Phone Phone - ### - ### ####
Relationship
Applicant's electronic signature:
Date Date / MM / DD YYYY
Spam Protection. Please answer this simple question:
What is "five hundred" as a number?

PAWS Ohio DOG/PUPPY ADOPTION FORM

PAWS Ohio DOG/PUPPY ADOPTION FORM

ABOUT YOU~

PREVIOUS PETS~

WHO WILL BE PRIMARILY RESPONSIBLE FOR CARE?:

WHO ELSE WILL BE RESPONSIBLE FOR CARE?:

Personal references