Contact Information Please complete the following information. Certain fields are required and this form cannot be submitted without them. Incomplete or inacurate information may delay adoption approval. Name * Address * City, State, Zip * Home Phone * Work Phone * Cell Phone Spouse's Name Spouse's Phone Email * Employment Information Please complete the following information. Certain fields are required and this form cannot be submitted without them. Incomplete or inacurate information may delay adoption approval. Employer * Employer's Phone Spouse's Employer Family Information Please complete the following information. Certain fields are required and this form cannot be submitted without them. Incomplete or inacurate information may delay adoption approval. Do you have children? * Yes No What are their ages? Does everyone in your household agree with this adoption? Yes No Household Information Please complete the following information. Certain fields are required and this form cannot be submitted without them. Incomplete or inacurate information may delay adoption approval. How long have you been at this address? * If less than two years, what was your previous address? I currently live in a house apartment mobile home I currently own my home rent my home live with someone else If you are renting, please list the landlord and phone number. Animal Adoption Information Please complete the following information. Certain fields are required and this form cannot be submitted without them. Incomplete or inacurate information may delay adoption approval. Which dog or puppy are you interested in adopting? This dog will be mainly indoors mainly outdoors both indoors and outdoors I currently live in the city out in the country Does your home have a fenced yard? Please describe type of fence (height) and size of yard. * If an outside dog, is there adequate shelter for winter? Please describe shelter. Do you agree to spay or neuter this dog if not already altered? Yes No Do you plan on breeding this dog? Yes No Will you annually vaccinate and provide veterinary care as needed during the term of this dog's life? Yes No Who is your current veterinarian and what is his/her phone number? Other Pet Information Please complete the following information. Certain fields are required and this form cannot be submitted without them. Incomplete or inacurate information may delay adoption approval. Do you have other pets? Please list breed, sex, age, etc. * Are your current pets spayed, neutered, and vaccinated? Yes No What pets have you had in the last ten years and where are they now? Personal Reference Information Please list 3 personal references who are not living with you and are not family. Please give thier name and phone number. Reference #1 * Reference #2 * Reference #3 * Final Information Please complete the following information. Certain fields are required and this form cannot be submitted without them. Incomplete or inacurate information may delay adoption approval. Are you aware often times the complete history of a stray or abandoned animal may not be known and you may encounter some behavioral problems? * Yes No Are you willing to work with our group on correcting these problems? * Yes No Are you physically and financially able to care for this animal? * Yes No Do you agree to keep this animal for life and return it to the shelter if you cannot? * Yes No I certify the above information provided is true and correct and understand Paws For Life may verify it before adoption is approved. Yes must be checked to submit form. * Yes Name * Address * City, State, Zip * Home Phone * Work Phone * Cell Phone Spouse's Name Spouse's Phone Email * Employer * Employer's Phone Spouse's Employer Do you have children? * What are their ages? Does everyone in your household agree with this adoption? How long have you been at this address? * If less than two years, what was your previous address? I currently live in a I currently If you are renting, please list the landlord and phone number. Which dog or puppy are you interested in adopting? This dog will be I currently live Does your home have a fenced yard? Please describe type of fence (height) and size of yard. * If an outside dog, is there adequate shelter for winter? Please describe shelter. Do you agree to spay or neuter this dog if not already altered? Do you plan on breeding this dog? Will you annually vaccinate and provide veterinary care as needed during the term of this dog's life? Who is your current veterinarian and what is his/her phone number? Do you have other pets? Please list breed, sex, age, etc. * Are your current pets spayed, neutered, and vaccinated? What pets have you had in the last ten years and where are they now? Reference #1 * Reference #2 * Reference #3 * Are you aware often times the complete history of a stray or abandoned animal may not be known and you may encounter some behavioral problems? * Are you willing to work with our group on correcting these problems? * Are you physically and financially able to care for this animal? * Do you agree to keep this animal for life and return it to the shelter if you cannot? * I certify the above information provided is true and correct and understand Paws For Life may verify it before adoption is approved. Yes must be checked to submit form. *