Name:    Age: Date:

Address: City/State: Zip:

Home #:    Work #:Other:

E-Mail address:

Occupation : Company Name:

What type of animal are you looking for (check all that apply):

Companion House Pet Outdoor PetGuard Dog Gift

If this pet is for a gift, for who?

Does person know they are getting a pet as a gift? Yes No N/A

Do you currently own any pets? Yes No   If Yes, please list below:

1) Species    Male/Female Male Female N/A Spayed/Neutered Yes No N/A

Inside/Outside Pet? Inside Outside Both N/A Age  Years Owned

2) Species    Male/Female Male Female N/A Spayed/Neutered Yes No N/A

Inside/Outside Pet? Inside Outside Both N/A Age  Years Owned

3) Species    Male/Female Male Female N/A Spayed/Neutered Yes No N/A

Inside/Outside Pet? Inside Outside Both N/A Age  Years Owned

Who is your Veterinarian/Clinic?

May we call your vet as a reference? Yes No N/A

If you have not had a vet in the past 3 years, who do you intend to use?

List all animals you have owned in the past 5 years:

1) Species    Male/Female Male Female N/A Spayed/Neutered Yes No N/A

Where did you get it? Years Owned 

What happened to this animal?

2) Species    Male/Female Male Female N/A Spayed/Neutered Yes No N/A

Where did you get it? Years Owned 

What happened to this animal?

3) Species    Male/Female Male Female N/A Spayed/Neutered Yes No N/A

Where did you get it? Years Owned 

What happened to this animal?

During the past 5 years, how many litters of puppies or kittens were produced by animals you owned or maintained?

How many of these litters were intentional on your part?

What happened to them?

Do you Rent  Own     Apt   House  Condo Duplex Mobile/Court

If renting, are pets allowed? Yes No N/A   Landlord/Bulding name

Landlord phone number

Does everyone in your household want and agree to adopt this pet? Yes No

If not, who does not?

Do you have a fenced yard? Yes No How high is your fence?

What type?      Chain wall? Yes No

If you do not have a fence please explain how you will handle your dog or puppy's bathroom & exercise?

How do you feel about pets being spayed or neutered?

Have you ever had a dog diagnosed with Heartworm Diesase? Yes No N/A

Do you know about heartworm preventative? Yes No N/A

Will you use Heartworm Prevention? Yes No

What kind of Heartworm Pevention will you use?

Will anyone be home during the day? Yes No If so who?

Please list ages of children living in the home.

Puppies need special attention.  If you are adopting a puppy into a home with young children, what special attention will you provide?

Does anyone in your household have allergies to animals? Yes No

Kind of pet allergy?

Do you travel often? Yes No If yes, how often?

How will this animal be cared for if you are gone for a week or more?

Are you planning to move? Yes No If yes, what will happen to this pet?

Have you ever taken an animal to a shelter/pound? Yes No

If so, where and why?

What circumstances would cause you to give up this pet?

How will you keep this dog on your property?

How many hours a day do you have to spend with this/train this animal (don't count sleeping hours)

Have you ever taken your puppy/dog to Obedience Training? Yes No

Are you willing to take this puppy/dog to Obedience Training? Yes No

Have you ever Crate Trained a puppy/dog? Yes No

Are you willing to Crate Train you new puppy/dog? Yes No

How will you house train this puppy/dog?

Dogs can dig, chew, bark, jump up on people and bite.  How do you plan to deal with these or any other potential problems?

How much of the 24 hour day will this animal be kept inside?

Where will this animal stay at night?

Are you aware that some doges live an average of 15 years or longer, while others live 8 years or less? Yes No

Are you aware that dogs need regular vaccinations and may require other routine veterinary care? Yes No

Are you willing to provide adequate medical care if this dog should become sick or injured? Yes No

A member of P.A.W.S. may visit your home (with an appointment)   after adoption.  Is that o.k.? Yes No

List two reference unrelated to you, one perferably a veterinarian (name/title/phone number)

In which ways did you hear about Plaquemines Animal Welfare Society having animals available for Adoption?  Newspaper Plaquemines Animal Welfare Society Website PETFINDER FriendPETsMART Veterinarian (name)