Street Paws Dog/Puppy Pre-Adoption Application

This application does not commit you to an adoption. It is used to screen those interested to make sure the home is a good match for the pet.

This questionnaire must be completed by anyone interested in adopting a pet from Street Paws. We at Street Paws try to place our animals into permanent and responsible homes while matching the pet to you and your lifestyle. NOTE: THE PROVIDING OF FALSE INFORMATION HEREIN WILL RESULT IN THE FORFEITURE OF ADOPTION FEES AND ANY ANIMALS ADOPTED. Street Paws reserves the right to refuse any applicant.*

I AGREE

In order for your application to proceed without delay, please add info@streetpaws.com to your email safe list to prevent our email reply from going directly to spam. Please call ahead to your vet to release ALL vet history. Please list all vet offices you have used on your application. If your pet was spayed/neutered at an alternate location please either provide documentation or the vet name and phone number where the pet was altered. If you do not have a vet history/reference please indicate no vet history below.*

I have read and understand

Date*

Date

Pet's name you are interested in adopting*

Where did you hear about this pet?*

Name*

First NameLast Name

Email*

example@example.com

Phone*

Please enter a valid phone number.Format: (000) 000-0000.

Please note that we can only accept applications from the potential owner. We do not accept applications on behalf of other family members or friends.

Age of Applicant*

You must be 21 years of age or older to adopt a dog or puppy.

Job Title*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long have you lived at this address?*

How many times have you moved in the last 5 years?*

Please describe your home*

Do you rent or own?*

If renting, you must provide your landlord/apartment information.

List landlord/apartment complex name & phone number or NA if you own your home: *

Are you allowed to have dogs in your home?*

Are you allowed to have any breed ie: bully breeds in your home? (many renters do not allow certain breeds)*

Do any children live with you?*

YesNo

Who do you live with?*

How many people live in your household? List relationship and ages if over 16.*

Do all members know that you plan to adopt a pet?*

Does anyone in your household have a pet allergy?*

YesNoNot sure

I am interested in adopting:*

Adult dog(s)Puppy(s)Senior dog(s)

Please indicate the reason for adopting a pet (check all that apply)*

Are you interested in a specific dog or puppy?*

YesNo

Please describe your ideal dog*

Personality, age, appearance, etc.

Have you owned a pet before?*

What procedures will you use for housebreaking?*

How will you handle chewing, digging or destructive behavior?*

Will your dog be allowed on furniture?*

Who would be responsible for taking care of your pet?*

How many hours each day would your dog be left alone?*

Are you or your spouse/partner currently employed?*

Please list occupation & hours/days worked per week (if no, please explain).*

Are you able to take your dog for an annual health check?*

YesNo

Could you afford to pay for emergency treatment?*

YesNo

Have you ever adopted from Street Paws or another shelter?*

YesNo

If yes, which shelter? If no, enter N/A*

Where is that pet now? Be specific. If no pet, enter N/A.*

How many cats, dogs, puppies or kittens have you owned in the past 10 years? Where are these pets now? List if currently owned and what type/kind (dog, cat, other and how many of each with age, sex and breed) If deceased please list cause of death. Be specific and list each pets name and how long you have had them. If no pet enter N/A*

Are/were your current/past pets spayed or neutered?*

If no, explain and be specific, if yes write N/A.*

Are/were your current/past pets shots up to date?*

If no, explain and be specific, if yes write N/A.*

What brand of pet food do you feed? List the brand and list if you feed wet, feed dry or feed both.*

Are/were your dogs on heartworm prevention?*

If yes, which brand or product? If no, enter N/A.*

Are/were your pets on flea prevention?*

If yes, which brand or product? If no, enter N/A.*

If yes, where do/did you purchase flea prevention?*

Current/most recent vet clinic used or N/A if no pets ever owned. *

Vet Phone # or 000-000-0000 if no pets ever owned.*

Additional vet clinic(s) name and phone number that have cared for your pets or N/A if no pets ever owned.*

In whose name are the vet records listed (if other than yourself?)*

Do/did your current/past pets live indoors or outdoors? *

Where will your new pet live?*

Where will your new pet sleep?*

When home alone, pet will be...*

Is there a yard available?*

If yes, is your yard completely fenced?*

Is your yard shared?*

How tall is the fence?*

What type of fencing?*

Is there a dog house?*

Do you have a swimming pool?*

Have you ever turned an animal in to Street Paws, another shelter or animal control?*

If yes, under what circumstance? If no enter N/A *

Have you ever had to give up one of your own pets?*

If yes, under what circumstances did you give up your pet? If no enter N/A.*

Has a dog/puppy died on your premises of distemper, parvo or unknown causes in the last 24 months?*

What do you plan to do with your pet when you go on vacation or have to leave town for an emergency? *

Are you willing and able to care for your dog for the full duration of its life?*

YesNo

If you had to move and could no longer keep your dog, what would you do?*

I understand that a copy of an official ID such as a driver's license will be required at adoption*

Would you allow an authorized representative of Street Paws to inspect the premises where the animal is being kept? Street Paws may request a virtual home visit. *

Have you ever been convicted of a felony? If yes, please explain. If no write N/A.*

Is there anything else you would like for us to know?*

The health of a dog is not guaranteed, and the health or personality of a dog can change over time.*

I agree

I will be responsible for all ongoing or one-off costs for medical treatments my dog may need*

I agree

I authorize Street Paws to contact the veterinarian office named above to confirm the medical records/history of my pets. By electronically signing below, I attest to the truthfulness of all my answers and that I have read, understood and agree with the following information. Falsification of any information above will be grounds for rejection of this application and possible removal of adopted pet from my home. Applicant must be 21 years of age or older. Although Street Paws works towards socialization of all animals and would not adopt out an animal that has demonstrated aggressive or potentially harmful behaviors, in submitting this form, I understand and agree that neither Street Paws nor any person or entity associated with, or working with, or on behalf of or as agent of Street Paws is liable for any injury(s), illness or damages that may result from my/our adoption of any animal. I also understand every effort has been made to insure the animal is healthy and all available medical information will be provided at adoption. Animals will be spayed or neutered and have age appropriate vaccinations prior to adoption. Street Paws strongly encourages all adopters to take their new pet to their veterinarian for an exam (at their expense) within 15 days of adoption. Street Paws is not responsible for further medical needs including but not limed to routine vaccinations, internal parasites, fleas, ticks, ringworm, upper respiratory infections, or other medical problem. I also understand that if I can no longer keep the pet, I will contact Street Paws immediately to discuss placement of the pet. the pet shall not be given away, sold or exchanged without prior written permission of Street Paws.**

I agree

Signature*

Street Paws Dog/Puppy Pre-adoption Application