First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

What is the Name of the Animal you are applying for:
Choose an animal: BINGO BLUE COMING SOON! BUBBA - COMING SOON! Clover Dusty Eden Felicity Grace GUM DROP / Gunner - CANDY LITTER Kiwi Lady - Road Puppy Litter Layla Little Bit (AKA Lilly) Mia MOOSE Natasha -Coming Soon! Nebel Penelope ROWDY - COMING SOON! Ruby Sammi & Stevie Bonded! Silver Snoopy - Peanuts Litter Snoopy - Road Puppy Litter Snow Spot - Road Puppy Litter Wanda

What is your Date of Birth*

Name of your spouse / significant other living in the home?*

What is the Spouse/ Significant Other Date of Birth?*

Do you own or rent your home*
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

If you rent, what is your landlord name and phone number?

How long have you lived at this address?*

If less than 2 years, what is the previous address ? If NA type NA

Do you intend to move soon?

What is the name and address of your employer*

How long have you worked for this employer?*

What is the employer of your spouse / significant other?*

How long has your Spouse / Significant Other been at this employer ?*

Are you able to make a LONG TERM commitment to care for a pet?*
Choose one: Yes No

List the Names and Date of Birth of other human members of the household*

Are all members of the household "on board" with and excited about adopting a pet?*

Does anyone in your household have allergies or asthma?*

Why do you want a cat/Kitten?*

Do you intend to use this as a barn cat?*
Choose one: Yes No

Do you plan to declaw?*
Choose one: Yes No

Our rescue group does not allow declawing. As part of the adoption contract, you will have to agree not to declaw this cat. Are you able to agree to this?*
Choose one: Yes No

How much time will the animal spend alone during the day*

Will the animal have access to all parts of the home?
Choose one: Yes No

Will you let your cat outside?*
Choose one: Yes No

If so, will it be harnessed and leashed?*
Choose one: Yes No

Are you willing to be patient and take time to allow your pet to adjust to you and your home?*

List All Pets Currently living in your home: Include Pets Name, type (dog.cat, etc), breed (dog), sex, state if spayed/neutered, inside/outside, age. If none, write "NONE"*

List all pets you have owned in the past five years that no longer live with you. Include pets name, type, sex, age, spayed/neutered, kept inside/outside/both, and what became of that pet. If none, write "NONE":*

Have you ever given up a pet? If yes, please explain*

List your present and /or previous veterinarian(s) used. Include Phone Numbers and addresses. Please advise your veterinarian(s) that we will be calling - if they are aware, it will speed up the approval process. If none, write "NONE"*

Please provides the Name, Phone Number, Email and relationship to you of at least 2 people. Do not use relatives. Excellent references are people who know both you and your pets. We will call the references as part of the approval process. *

How Did you Hear About Paws Up Pet Rescue?*
Choose one: Online Newspaper Ad Previous Adopter Word of Mouth Friend

By choosing "yes" below, I certify that the information I have given is true and that I recognize that any misrepresentations of facts may result in my losing my privilege to adopt a pet. I understand that Paws Up Pet Rescue has the right to deny my request to adopt an animal, and I understand that I authorize investigation of all statements in this application, including veterinary records. I certify my understanding of these things.