Fields marked with an asterisk (*) are required.

* Name:

* Address:

* City: , * State: , * Zip:

* Home Phone: Work Phone:

Cell Phone: * e-mail:

Place of Employment:

If you are a student, what year are you in?

If you are a student, please list:
Your parent's name(s):

Phone number:

Address:

Animal(s) Interested In:

Why are you interested in this particular animal?

What are the needs of this particular breed?

Number of adults in household:

Their ages & relationship to you:

Is anyone in the household allergic to dogs or cats? Yes No

Number of children in household: Ages (ex: 3, 7, 15):

Other companion animals in the household (breed, gender, age):

Are they neutered/spayed? Yes No If not, why not?

Name & phone number of vet:

Please list companion animals you have had in the past:

1. Breed: What happened to him/her?

Number of years you had this animal:

2. Breed: What happened to him/her?

Number of years you had this animal:

3. Breed: What happened to him/her?

Number of years you had this animal:

4. Breed: What happened to him/her?

Do you: Own Rent Type: House Apartment Condo Mobile Home

How long at present address?

Do you have your landlord's permission to have pets? Yes No N/A

How many? Can you provide a copy of your lease? Yes No N/A

Is there a weight/size restriction? Yes No What is this restriction?

Name of landlord:

Phone number of landlord:

Where will the animal be kept during the day?

Where will the animal sleep at night?

Where will the animal be kept when you are at work, or away from home?

How will the animal be cared for during overnight absences or while on vacation?

How many hours a day would the animal be outdoors?

How many hours a day would the animal be indoors?

How many hours a day would the animal be left home alone? <1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 >10

Are you planning on declawing a cat? Yes No

If you plan on crating training, how many hours a day will the dog be crated?

Do you have a fenced area? Yes No

How large is it? How high is the fence?

What type of fencing (chain link, privacy wooden, etc.)?

How will a dog be exercised?

Who will be the main caregiver of this animal?

How would you discipline your animal?

What are your thoughts on obedience training?

Have you ever obedience trained a dog before? Yes No How?

Are you willing to housetrain a dog? Yes No Are you willing to take a dog for obedience classes? Yes No

List the types of behavior problems you consider NOT acceptable & what you would do to correct these behaviors:

What would you do if you could not keep the animal? Please be specific.

What circumstances, in your opinion, justify getting rid of an animal?

At what point would you consider euthanasia should your dog become ill?

What do you estimate the yearly expenses will be for animal care?

Thank you for your interest in a Pound Pals rescue animal.

Pound Pals animals are placed in screened homes. We require a home visit prior to adoption to ensure the new home is a good match for both the animal and the family.

Adopters must be at least 18 years old.

Our volunteer rescue and rehabilitation efforts are funded through adoption donations and contributions. We receive no public funds. Pound Pals is a private, non-profit 501(c)(3) organization. Donations to Pound Pals are tax-deductible.

Pound Pals retains the right to refuse any adoption.

I certify that the above information is correct and understand that the above information will be verified.

If you have questions related to the animals listed or inquiries regarding the Pound Pals organization, please email pals@psknet.com. Thank you.