PRAIRIELAND ANIMAL WELFARE CENTER ADOPTION APPLICATION
(PLEASE PRINT)
The staff and volunteers
care greatly for the animals under our supervision. It is our responsibility to
find permanent loving homes for these animals. We do have adoption guidelines,
and reserve the right to deny any adoptions that we feel are unsuitable.
Last
Name____________________________ First Name_____________________________ Phone:___________________________
Address_______________________________________________ City_________________________
County_________________
ID#
of Pet Interested in Adopting_____________________ Who is your current
veterinarian_________________________________
Will
this be your first experience with a pet? ¨Yes ¨No
Does
anyone in your household have allergies to animals? ¨Yes ¨No
Have
you ever adopted from PAWC before? ¨Yes ¨No
Do
you still have that animal? ¨Yes ¨No If no explain________________________________________________________
Have
you ever released an animal to PAWC or any other shelter? ¨Yes¨No If Yes explain_________________________________
Do
You:¨Own ¨Rent
¨Live with Parents ¨House ¨Condo ¨ Duplex ¨ Mobil Home
If renting, Landlords
Name___________________________________ Phone: ____________________________________________
Are
you a full time student? ¨ Yes ¨ No Are you
employed? ¨Yes ¨No If yes where? __________________________
If No, how do you plan to pay for
your pet’s food and medical care? _____________________________________________________
Number
of adults in household_______ Number of children_______ Ages of
children_______________________________________
Are
you prepared for the responsibility of this pet for its lifetime? ¨Yes ¨ No
It
may take your pet a month or longer to adjust to a new home. Are you willing to
allow this much time for an adjustment?
¨ Yes ¨ No
Do
you agree to return the animal to PAWC if you no longer can care for this
animal? ¨Yes ¨No
Current Pets list
any animals you currently own
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of Pets |
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Sex
/ Breed |
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Age |
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Years
owned |
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Spayed/
Neutered |
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Vaccinations
Current |
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Previous Pets list all animals you have owned in the past 5 Years
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Name |
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Cat
or dog |
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Breed
(s) |
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Age |
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How
long owned |
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What
happened |
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Spayed/Neutered |
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Please fill
out this section if you are Applying to adopt a Cat
Why are you adopting a cat?
¨ Pet/Companion
¨ Children ¨
Gift ¨
Mousing ¨Other
(explain)___________________________________
Where will your cat be kept during the day?
¨ Loose in house ¨ Outside ¨ Garage ¨ Basement ¨ Other (explain)
________________________________
Where will your cat be kept in the evening?
¨ Loose in house ¨ Outside ¨ Garage ¨ Basement ¨ Other (explain)
________________________________
Will your cat be allowed outside ¨Yes ¨No
Please fill
out this section if you are applying to adopt a Dog
Why are you
adopting a dog?
¨ Pet/Companion ¨ Children ¨Gift ¨ Hunting ¨ Companion other pets ¨Other (explain)
_________________
Where will
your dog be kept during the day?
¨Loose in house ¨ Crate/kennel in house ¨ Basement ¨ Garage ¨Fenced in Yard ¨ Outside in kennel
¨ Outside on chain ¨ Other (explain)
____________________________________________
Where will
your dog be kept at night?
¨Loose in house ¨Crate/kennel in house ¨ Basement ¨ Garage ¨Fenced in Yard ¨ Outside in kennel
¨ Outside on chain ¨ Other (explain)
_____________________________________________
Where will
your dog sleep at night? ______________________________________________________________
Do you have a
fenced in yard? ¨ Yes ¨ No
How will you
housebreak your dog?______________________________________________________________
Would you
consider Crate Training?_________ Obedience Training_________
On Average,
how many hours will your dog be left alone each Day?_____ Night_______
I certify that the information provided on this application is true, accurate, and complete, and I recognize that any false information or misrepresentation of fact provided may result in losing adoption privileges. I understand that the adoption of this animal may be delayed until the information is verified. I further understand that PAWC maintains the right to refuse any adoption inn the best interest of the animal.*** Prairieland Animal Welfare Center is operated by the Knox County Humane Society
Signature:______________________________________ Date:__________________