Name of Dog(s) you are interested in adopting.
*
If you are not applying for a specific dog, please tell us your preference in age range, sex, and weight of the dog you would like to adopt.
Applicant Full Name
*
First Name
Last Name
Co-Applicant Full Name
If Applicable
First Name
Last Name
Phone Number
*
(###)
###
####
Email Address
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Your Age
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Number of Adults Living in the Home
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1
2
3
4
5
6+
Number of Children Living in the Home
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0
1
2
3
4
5
6+
Age of Children
If Applicable
Do you Own or Rent?
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Own
Rent
Other
How long have you lived at this address?
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Type of Residence
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Single Family Home
Condo
Apartment
Townhouse
Mobile Home
Other
Do you have a backyard or private outdoor space?
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Yes
No
Employment Status
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Employed Full Time
Employed Part Time
Unemployed
Retired
Other
What are the work hours for all adults living in the home?
*
If unemployed or retired, please enter N/A
Does anyone in your home have a pet allergy? If yes, please explain:
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Do all family members want to own a dog?
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Yes
No
Undecided
Describe your household
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(check all that apply)
Active
Average
Quiet
Noisy
Additional information that describes your home environment
Do you currently have any pets?
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Yes
No
Describe all current pets (type, size, age, temperament)
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If none, please say N/A
Are current pets spayed/neutered?
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Yes
No
Not Applicable
Are current pets up to date on vaccines, heartworm and flea/tick prevention?
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Yes
No
Not Applicable
Have you owned dogs in the past? (Please provide a brief history. If deceased, state dog’s name, date and nature of death).
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Have you relinquished a pet to a shelter or rescue group in the past? If so, describe:
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How many hours a day will your dog be alone?
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Where will the dog be kept when you are not home?
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Where will your dog sleep?
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Do you intend on crating the dog? If so, when and for how long?
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How often do you travel? (work and personal)
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When traveling, who will care for your dog?
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How will you train/discipline the dog? Please explain:
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How often will the dog be brought outside to relieve himself? And by whom?
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Who else will be spending time with your dog?
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In the event you are unable to care for the dog due to emergency or medical reasons, who would care for it?
*
Why do you want to adopt a dog?
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Explain what type of personality would fit best into your home and why
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Would you be open to a home visit as part of the adoption process?
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Yes
No
Have you ever applied for a dog from Paws4Survival before?
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Yes
No
Veterinarian Address & Phone Number
This field is required if you have past or present pets.
Personal References Name & Phone Numbers:
*
Please include at least two references, non-family members
How soon are you looking to adopt?
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Paws4Survival Rescue requests an adoption fee of $500. Is this acceptable to you?
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Yes
No
By checking this box, I certify that the above information is true and accurate to the best of my knowledge. I understand that completion of this form in no way guarantees my ability to adopt a dog. I further understand this is only the first step in the adoption process.
*
Yes