Procedure: * Completely fill out & sign application. * You will hear back within 7 days, or please assume your application was not selected. * For applications selected, a vet-check will be done, then a home visit made. * If the adoption is approved, an adoption contract will be completed, donation accepted, and then you take your new canine friend home.

Today's Date: _____________ Show Location: _____________ Applying to: ___ Foster ___ Adopt

Name of Dog(s) Applying for: _________________________ Breed/Type: ________________

Where did you hear about PAW (if newspaper, which one)? ____________________________________________

Please print identification information clearly, especially email address:

Applicant(s) Name: _________________________________________________________________

Address: ________________________________________________________________________

City: ________________________________ State: _______ Zip: ___________

Place of Employment: _______________________________________ Since (mo/yr): ______

E-mail: ______________________ Home Phone: (____)___________ Work Phone: (____)___________

1. Why do you want to adopt a dog?

2. What do you think are the most important responsibilities in owning a dog?

3. Please list any preferences (age, sex, breed, personality):

4. Have you submitted an application with another organization for a dog at this time? ___yes ___no

5. Have you ever had an application declined for adoption of an animal from an animal welfare group/animal control facility? ___yes ___no Explain:

6. Are you willing to take the time to housebreak a dog, and do you understand that changing a dog's environment may cause the dog to have accidents? ___ yes ___no

7. If a behavioral problem arises, what steps will you take to work on it?

8. If you are applying for a puppy/dog who is not housetrained, how will you housetrain the dog:

9. Does any member of the family have any allergies to animals? ___yes ___no Explain:

10. Describe the kinds of personal situations where you might have to return your adopted dog, i.e., job loss, children, move, marital change, etc.

11. For whom are you adopting the dog? ___self ___ gift ___other family member

12. How many people live in your home?

13.Are there any children in the household? ___yes ___ no If yes, what are their ages? Note: PAW often does not place dogs in homes with children under age 6)

14. Who will be responsible for feeding and taking the dog outside?

15. Who will take care of the dog in the absence of the primary caretaker?

16. What reading and other/or steps have you taken to prepare for a new dog?

17. Will you take obedience training?

18. Will you be willing to obtain an appropriately sized, open-wire crate, if recommended? ___yes ___no

19. What kinds of animals have you owned?

20. Describe those pets you currently own:

If you have more animals than space provided, please use an additional sheet of paper and attach to this form.

a. Name __________________________ Type _____________________ Age _________ Sex ______________

Is the pet Spayed or Neutered? ___ yes ___ no

Primarily Indoor or Outdoor? Explain:

What year did you get the animal?

How did you acquire the animal?

Comments:

b. Name __________________________ Type _____________________ Age _________ Sex ______________

Is the pet Spayed or Neutered? ___ yes ___ no

Primarily Indoor or Outdoor? Explain:

What year did you get the animal?

How did you acquire the animal?

Comments:

21. Describe all pets you previously owned in the last 10 years:

If you have had more animals than space provided, please use an additional sheet of paper and attach to this form.

a. Name __________________________ Type _____________________ Age _________ Sex ______________

Was the pet Spayed or Neutered? ___ yes ___no

Primarily Indoor or Outdoor? Explain:

What year did you get the animal?

How did you acquire the animal?

Year deceased (or last year you had pet)?

Cause of death, or where pet is now (detail):

b. Name __________________________ Type _____________________ Age _________ Sex ______________

Was the pet Spayed or Neutered? ___ yes ___no

Primarily Indoor or Outdoor? Explain:

What year did you get the animal?

How did you acquire the animal?

Year deceased (or last year you had pet)?

Cause of death, or where pet is now (detail):

22. List each vet/animal hospital where your animal(s) received care over the last 10 years:

If several vets were used, please explain and provide approximate service dates. Please note that application review cannot be completed unless each vet's phone number is provided. If the space provided is insufficient, please use an additional sheet of paper and attach to this form.

Name(s) and Phone # with area code (for each):

What owner name(s) are records listed under?

Date of last vet visit:

23. Name of vet you will use for your new pet:

24. What kind of veterinary care do you plan to provide?

25. Have you considered the extra expenses that will come with having a dog including vet care, food, supplies and equipment, toys, training and boarding? Please explain:

26. What type of home do you live in? _house _townhouse _duplex _condo _apt _mobile

27. Do you own or rent your residence? ___own ___rent

28. If you rent: Landlord name _________________ Landlord phone #(____) ________

What type/size pets are allowed?

If you have rented your current residence for under a year, please provide prior address and prior landlord contact phone number:

Prior address:

Prior Landlord's name:_________________ Landlord phone #(____) ________

29. Do you have a fenced yard? ___yes ___ no

Note: Secure, fully fenced yards are typically required for homes with children under age 12. For some dogs, fences of minimum 5 to 6 ft are required.

What type of fence?

How tall? (Give range of heights, if relevant)

Does the fence belong to you, or to neighbors?

Any holes or gaps? ___yes ___no

Is the fence attached to the home? ___yes ___no

30. If you do not have a fence, do you plan to install a fence? ___yes ___no. If yes, when?

31. Describe the circumstances in which you would walk/exercise a dog on leash:

32. Describe the circumstances in which you would walk/exercise a dog off leash:

33. How often will you exercise the dog and for approximately how long?

34. How many hours will the dog be left unattended (i.e., workday)?

35. When you are home, where will the dog be kept?

36. Where will the dog sleep?

37. When no one is home (i.e. at work, shopping), where will the dog stay (be specific)?

38. Have you used or do you plan to install a dog door?

39. How often do you travel?

40. What will you do with the dog when you travel?

41. If you move, what will you do with the dog?

42. Are you or your spouse with the military? ___yes ___no

43. Are you aware PAW requires all dogs/cats in a home be spayed/neutered? ___yes ___no

44. Are you aware of the adoption fee ($175 nonrefundable donation)? ___yes ___no

45. Are you familiar with your local animal control laws? ___yes ___no

46. Have all adult family members met with and agreed upon the dog?

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that the Partnership for Animal Welfare, Inc. (PAW) reserves the right to annul the adoption and reclaim the animal. I give the Partnership permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a Partnership volunteer before an adoption decision is made.

In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal. I understand it is the Partnership's prerogative to decide which home is most appropriate and that their decision is final, and therefore I will not argue with the decision. Unless otherwise indicated by the Partnership, I am free to apply and undergo the application process in the future.

Signature(s) __________________________________________________ Date _______

Printed Full Name(s) ________________________________________________

Rev. 8-18-02