| Adoption Application Paul_Warner_Rescue@yahoo.com Paul Warner Rescue Paris, Illinois Phone: (217)-822-6060 To help ensure the best possible placement of our rescued animals, and in order to determine that the proposed adoption is in the best interest of the animal, you, and your family, please complete each of the following questions. Please be as thorough as possible. The Paul Warner Foundation reserves the right to refuse adoption to any application. Type of Animal You Wish to Adopt: __________________________ Name of Animal: __________________________________________ Your Name: _______________________ Spouse’s Name: ______________________ Address: _______________________________________________________________ City: ______________________________ State: ___________ Zip: _____________ Home Phone: _________________________ Work Phone: _____________________ Place of Employment: ____________________________________________________ Name Personal Reference: _________________________________________________ Relationship: _________________________ Phone: ___________________________ Household Information: 1. Do you live in a: House ____ Apartment ____ Condo ____ Mobile Home ____ 2. Do you: Own ____ Rent ____ Live at Home ____ 3. If you rent: Are pets allowed? Yes No o Landlords name and phone: ________________________________________ ________________________________________ o Does your landlord require a security deposit? Yes _____ No _____ 4. Length of time at current residence? _____ Less than 1 year (If selected, please provide previous address) Previous Address: ________________________________________________ ________________________________________________ _____ 1-3 years _____ 3-5 years _____ 5+years 5. If you are planning on adopting a dog, do you have a fenced-in yard? Yes ____ No ____ What type of fence (chain link, stockade, etc.)? _________________________________ If you do not have a fenced yard, what arrangements do you plan to make for exercise and toilet duties: _________________________________________________________ _______________________________________________________________________ 6. Number of adults in home: ______________________________________________ 7. Number of children in home: ______ Age of children: ______________________ 8. Do you have a swimming pool? Yes _____ No _____ 9. Have allergies to animals been a problem to any household member? Yes ____ No ____ 10. Are all family members aware that you are considering adopting a pet? Yes ____ No ____ Do they all approve? Yes ____ No ____ Pet History: 1. Do you own other pets? Yes ____ No _____ Total number of animals: _________ If yes please complete information below. Are they current on their vaccinations? Yes _____ No _____ Are your dogs on Heartworm preventatives? Yes _____ No _____ Do your cats go outside? Yes _____ No _____ Animal 1 Name: ________________ Type/Breed: ______________ Sex: _____ Age: _____ Neutered/Spayed? Yes _____ No _____ Length of ownership: _______________ Animal 2 Name: ________________ Type/Breed: ______________ Sex: _____ Age: _____ Neutered/Spayed? Yes _____ No _____ Length of ownership: _______________ Animal 3 Name: ________________ Type/Breed: ______________ Sex: _____ Age: _____ Neutered/Spayed? Yes _____ No _____ Length of ownership: _______________ 2. Have you had other pets in the last five years? ______________ What happened to them? _____________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. Have you ever given up a pet for adoption? Yes _____ No _____ If yes, please explain the circumstances: ________________________________________ _________________________________________________________________________ _________________________________________________________________________ 4. Have you ever adopted from the Paris, Illinois area before? _______________________ 5. Have you ever surrendered an animal to an animal shelter? _______________________ Pet Information: 1. Will there be someone home with your pet during the day? Yes _____ No _____ 2. What is the greatest number of hours the pet will spend alone daily/nightly? Hours: ______ 3. Where will the pet spend most of its time? Crate ___ Indoors ___ Outdoors ___ Garage ___ Basement ___ Run ___ 4. Where will your new pets main sleeping quarters be? Crate ___ Pet Bed ___ Share bed with owner ___ Designated Room ___ Outdoors ___ Garage ___ Basement ___ 5. Is there someone home at night? Yes ___ No ____ 6. Do you plan to travel with your pet? Yes ____ No ____ 7. If not, where will the pet stay while you are away? Friend or Family ____ Kenneled ____ In home pet-sitting ____ 8. Have you ever taken a dog to obedience class? Yes ____ No ____ 9. Have you ever crate trained or house trained a dog? Yes ____ No ____ Veterinarian Information: 1. Name of current veterinarian: ______________________________________ 2. Name & location of Animal Hospital: ________________________________ _________________________________________________________________ 3. How much do you think this pet will cost you each year (please include food, heart worm preventative, flea control, medical and dental care, supplies, training, grooming, boarding costs and toys)? ___________________________________ Post Adoption Requirements: 1. If you adopt a puppy or a kitten, you’re required to sterilize him or her by six months of age if the pet is not already sterilized. 2. You would return the animal to us if you feel you cannot keep him/her. You must not sell the animal or give it to anyone else. 3. You are responsible for providing proper shelter, food, water, exercise, medical care and humane treatment at all times for your companion animal. I certify that the information given on this application is true and correct. If I am approved by the Paul Warner Foundation to adopt an animal, I agree to all the above requirements. I understand that failure to comply with any of the requirements will result in confiscation of adopted animal. Signature of Applicant: _______________________________________ Date: ______________________________________________________ |