Basic Information
Adoption Request
Pets Currently In Home
Past Pets
Terms & Conditions
1/5
First Name*
Middle
Last Name*
Occupation of self or partner
How long have you been employed?
Name of Employer
Address*
Apt/Suite
City*
State* ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Zip Code*
Type of Housing Single Family HomeMilitary HousingApartmentTownhouseCondominium
Do you rent or own this property? Rent/LeaseOwn (including Mortgage)
Name of Landlord
Landlord Phone Number
Will you provide written permission from the landlord? —Please choose an option—NoYes
Cell Phone*
Home Phone
Email*
Preferred Method of Contact* —Please choose an option—Cell PhoneHome PhoneEmailCell Phone (text)
Occupation
Employer
Number of Adults in Household:
Number of Minors in Household:
Would you be willing to allow a PACA/AAR representative to do a home visit prior to adoption or any time after adoption? YesNo
Name of Dog(s) Requested for Adoption*
What attracted you to this dog?*
Do you prefer a dog or puppy? Adult DogPuppyNo Preference
This dog is for: SelfChildGiftOther
Type of dog desired: House PetOutdoor DogWatchdogOther
Do you have a fenced or walled yard? NoYes
Type of Fence/Wall —Please choose an option—Cinder BlockWood/Vinyl/Solid MetalChain LinkLivestock BarrierOther
How tall is your Fence/Wall?*
Do you have a doggy door? NoYes
How many hours a day will the dog be left alone?
Where will the dog stay when left alone?
How will the dog be primarily confined to your property? In the HouseOutdoor KennelFenced YardChainedPatio AreaOther
If you have a pool, how is it secured from pets?
How will you exercise your dog?
Do you plan to take your new dog to obedience classes? YesNoOnly if Needed
Are you aware pets need yearly vaccinations and veterinarian visits? NoYes
Name and Phone Number of your current veterinarian (if applicable):
Do any of your pets ride in an open pickup truck bed? NoYes
Under what circumstances would you NOT keep this pet? DivorceNew BabyAllergiesJob Change/MovingGot Another PetCan't Afford Vet BillsDoesn't Get Along with Other PetsOther
Do you have pets currently living with you at home? None12More than 2
Where do your pets stay at night?
Where do your pets stay during the day?
Do you have any free-roaming poultry or livestock? NoYes
Pet #1
Type of Pet —Please choose an option—DogCatRodentReptileBirdOther
Age of Pet
What breed of dog?
Is this pet male or female? FemaleMale
Is this pet spayed or neutered? NoYes
What is the pet's energy level? —Please choose an option—LowMediumHigh
Pet #2
Type of Pet DogCatRodentReptileBirdOther
List any other pets here:
Please list this information about Pet #1 (no longer living with you): Cat or Dog, Breed if Dog, How long you had pet, what happened to the pet?
Please list this information about Pet #2 (no longer living with you): Cat or Dog, Breed if Dog, How long you had pet, what happened to the pet?
Please list any other pets in the past five years that are no longer living with you and why.
Animals going to a new home will need time to adjust to their new surroundings. Please realize it will take about 2 weeks for a new pet to start accepting everyone, especially another pet(s).
Do you understand that pet ownership is a lifetime commitment to provide care (including veterinary care) and a permanent, safe home for the life of your new pet?
NoYes
Puppy Adoption Requirements: I understand that a puppy will require vaccinations and spay/neuter BEFORE the final adoption is approved by PACA. Until the adoption is finalized via signing of the adoption contract by a PACA representative, the puppy will remain property of PACA. If I fail to get the required vaccinations or spay/neuter performed at the vet of PACA's choice, or pay for these procedures at a vet of my choosing and supply PACA with required paperwork, I agree and acknowledge that PACA may reclaim their puppy. My signature below states I have read and agree to the puppy adoption requirements.
No warranty or representation of any kind is made by PACA/AAR as to the health, disposition, or suitability of this dog as a domestic animal or, specifically as to any hazard it may present to known or unknown adults, children, or other animals or property. Should any dog on a trial period or adopted from PACA/AAR create a hazard to persons or property or cause injury to either, Applicant or Adopter agrees to hold blameless PACA/AAR, its agents, board of directors, staff, volunteers, representatives, heirs and assigns, in perpetuity. I certify the answers to this questionnaire to be true and that any false information may result in nullifying the adoption. Sign here
Signature
Date
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