Name*
Date of Birth (PAWS cannot adopt to anyone under 18 years old)*
Full Address (include city, state, zip code)*
E-mail Address*
Home Phone*
Cell Phone
Alternate Phone
Which pet are you applying for? (name or description)
Are you:	Employed Student Retired Other
Type of Residence:	House Apartment Mobile Home Office Own Rent
If you rent, does landlord allow pets?	Yes No
Landlord's name
Landlord's phone number (will be verified by a PAWS representative)
What times would be best for a PAWS representative to call or visit?
Do you plan to move in the near future?	Yes No
If you move in the future, will you be able to keep your pet(s)?	Yes No
Are other family members aware you plan to adopt a pet?	Yes No
Life style:	Extremely Active Moderately Active Somewhat Active Not Active
Are you?	Single Married Live with parents Couple, not married Military
Number of adults in household
Number of children at home
Ages of children
Currently have pets	Yes No
How many dogs
How many cats
How many other
Spayed or Neutered	Yes No
If not, please explain
Current on shots	Yes No
If not, please explain
What kinds of pets have you had in the past?
What happened to your last pet?
Have you ever lost a pet due to:	Poisoned Hit by Car Disease Stray/Stolen Old Age
Have you ever had to give up a pet?	Yes No
If Yes, why?
Have you ever gotten a pet or applied for a pet from another humane organization for an adoption?	Yes No
lf Yes, when?
What organization?
Is anyone in your family allergic to animals?	Yes No
Name of Current Veterinarian (if applicable)
Town
Phone number
Other personal reference (name and phone number)
Are you prepared and willing to meet the yearly costs of regular preventive care, possible additional vet care, and everyday food, supplies and training costs for your new pet? Estimate $150 - $250	Yes No
Your pet will live:	Indoor Outside Combination of both
If outside, what kind of shelter and confinement will be used?
Do you plan to use a kennel?	Yes No
How do you plan to housetrain?
Do you feel willing and able to work with your pet and correct problem behavior if it should develop? (examples - destructive, jumping, chewing, bathroom issues, etc.)	Yes No
What are your ideas for dealing with such behavior?
Who will be responsible for your new pet's care?
About how many hours a day will your pet be alone?
About how many days a week will your pet be alone?
Where will it be kept when left alone?
What type of I.D. do you plan to have for your pet?
Both PAWS adoption policy and Iowa law (for pets from pounds and shelters) require that adopted animals be spayed or neutered. Do you agree with this?	Yes No
Are you prepared to give your new pet plenty of time to adjust to its new home?	Yes No
PLEASE NOTE: If applying for a cat, whether your cat will live inside or outside, we strongly oppose declawing cats. Declawing a cat is the equivalent of cutting off a human’s finger at the first knuckle. Do you agree to NOT declaw this cat?*	Yes No
Has a trial home visit been discussed with you by a PAWS representative?	Yes No
What is your reason for wanting to adopt a pet?
Would you consider adopting two animals for companionship - especially if home alone often?	Yes No
I certify that the information I have given is true and authorize investigation of all statements made above. I understand that PAWS has the right to refuse any request for adoption. Adopter's name
Date: