Application for Pet Adoption
Animal Name:__________________________ Animal ID# _____________________________
Name_____________________________________ Phone _______________________Cell___________________
Physical Address__________________________________ Mailing Address ________________________________
City__________________________State__________Zip_________________
E-Mail_________________________________ DL#_____________________________ State______________
Emergency Contact & Phone _____________________________________________________________________
Please provide one professional and one personal reference. Example: Employer and Neighbor or Friend.
Name ______________________ Association _______________________ Phone Number _________________
Name____________________ Association _____________________ Phone Number ________________
Type of Residence (home/apartment/farm) ________________ Do you : Own _______ Rent________
Landlord Approval is required. Landlord’s Name __________________ Landlord’s Phone # ___________________
Does your job require you to travel frequently? _____________________
If so, do you plan on taking your pet with you? ___ Will you be utilizing a pet boarder or sitter? _______
Have you adopted from PAWS before?_____ Who did you adopt?________________ Dog or cat?______________
Are you currently on our Food Handout Program? _____ Have you ever been on this program? ________
How Will Pet Be Confined: _____Fenced _____Dog Run _____Trolley _____Stake _____ Other ________________
Where Will Pet Be Kept During Day? ___________________________ Overnight? __________________________
How many Animals Currently in Household ______ Dogs _____ Cats _____ Other: ______________________
Are your current animals spayed and/or neutered? _____ Do you intend to breed any of your animals in the
future? _____
Have you ever had Parvo, Distemper or Feline Leukemia in your household? _______ When? ________________
Children and Ages in Household: ____________________________________________________________
What are you seeking in a pet? ______________________________________________________________
Do you currently have a veterinarian? Please list here: _________________________________________
Are there any behaviors or traits you cannot tolerate in a pet? ___________________________________________
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~PAWS reserves the right to refuse any adoption~
Adoption Agreement
I understand that many of these animals are rescue animals and their medical history is unknown.
These animals are NOT tested for disease. The animal’s breed is not definite, and not guaranteed in
any way.________ (initial)
Furthermore, I agree that if this animal is not what I’m looking for, or I can no longer have an
animal where I reside, I will contact PAWS immediately at 541-276-0181 for re-adoption.
Unfortunately, no refunds will be provided outside of the 7 day trial period since fees are used for
spay/neuter costs. ________ (initial)
If the animal is not yet spayed or neutered, I agree to make arrangements with PAWS to have
this procedure done prior to the age of 5 months and/or within one month of adoption. I
realize that if this animal is not altered as directed, I may be forced to relinquish ownership
and return the animal to PAWS. I agree to a pre- or post-adoption home inspection by a PAWS
representative, if requested.
This application is Confidential. I agree to authorize the release/disclosure of records and/or
information concerning the above provided information. Release of Liability: I fully understand that
adoption of this/these animals carries a risk of injuryincluding being bit or scratched. My signature
below attests to my intent to hold harmless and release from all liability PAWS, its agents and
assignees from all acts which are related to normal risk associated with the adoption of an animal
including any illness this animal may incur or currently have.
Print Name:___________________________________________
Signature: ____________________________________________ Date:____________________
To be completed by PAWS staff:
Five Month S/N Date _________ Already Sterilized________ Appointment Date_____________
Pick Up Date_____________ Animal Name ______________________________ Animal ID __________________
Age_________ Adoption Fee $____________
Adopter is paying to HOLD. Paid by cash, check, credit $___________ VISA / MC / DISC (LAST 4)________________
Received by _______________________
Adopter is paying IN FULL. Paid by cash, check, credit $___________ VISA / MC / DISC (LAST 4)________________
Received by _______________________
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