General Information

First Name (required)

Last Name (required)

Street Address (P.O. Box Not Accepted)
Apartment or Suite

City State (Abbreviation) Zip

Home Phone (required)
Work Phone 
Cell Phone   

Email Address (required)
Would you like to be on our mailing list? Yes No

Do you rent or own your home, or other?
If other, where do you live?

How long have you lived at your present address? Months Years

Live in an apartment or rent a home? Yes No   

If Yes, Name of Apartment Complex/Landlord Phone

Does the Apartment Complex/Owner require a pet deposit? Yes No

If Yes, have you already paid the deposit? Yes No

Who lives in your household? Adults Children
Ages of Children

What type of activity level do you have in your home? High traffic/Very busy Moderate/Some activity Quiet/Slow paced

Does anyone have allergies to animals? Yes No
If yes, how severe?

Place of Employment
How Long? years months

Information About Pet for Adoption

Name of Animal you would like to adopt Cat Dog

Breed Color/Markings

Age Sex Male Female

Will this animal live Inside Outside Both

If applying for cat, do you plan to declaw? Yes No Maybe

Why do you want this animal?

Does everyone in your household want an animal? Yes No

Who will be responsible for the care of the animal?

If you move to a place in the future where pets are not allowed, what would happen to the animal?

Would you object to an APAWS representative visiting your home? Yes No

Have you every applied to adopt an animal before? Yes No

If yes, which agency did you apply with?

Were you able to adopt the animal you applied for? Yes No

If no, why not?

Information About Past and Current Pets

Who is your current veterinarian?
Name Address
Phone Number

When and why was your last visit?

Have you owned pets in the past 5 years that are no longer with you? Yes No

If Yes, please list below

If No, skip to next question

Name Dog Cat      Breed
How Long Kept?
Why do you no longer have the pet?

Name Dog Cat      Breed
How Long Kept?
Why do you no longer have the pet?

Name Dog Cat      Breed
How Long Kept?
Why do you no longer have the pet?

Do you have any pets at home now? Yes No

If Yes, Please list below:

If No, skip to next question

Name Dog Cat
Age Months Years
Spayed/Neutered Yes No
Current on Vaccinations Yes No      
Pet is Kept Inside Outside Both

Name Dog Cat
Age Months Years
Spayed/Neutered Yes No
Current on Vaccinations Yes No      
Pet is Kept Inside Outside Both

Name Dog Cat
Age Months Years
Spayed/Neutered Yes No
Current on Vaccinations Yes No      
Pet is Kept Inside Outside Both

Name Dog Cat
Age Months Years
Spayed/Neutered Yes No
Current on Vaccinations Yes No      
Pet is Kept Inside Outside Both

For Dogs

Front Yard: Fenced No Fence       
If Fenced: Type Min. Height Secure? Yes No

Back Yard: Fenced No Fence       
If Fenced: Type Min. Height Secure? Yes No

Issues to Consider

How do you plan to introduce your new pet to existing pets?

How much money do you think it will cost to take care of your new pet for one year?

Cats can live longer than 15 years. Dogs often live between 10-15 years. Are you willing to care for a cat or dog for that long? Yes No

Are you prepared to accept the habits and lifestyles of cats/dogs, such as jumping on furniture and countertops, shedding, scratching or chewing belongings, occasional accidents, etc?
Yes No

What do you consider unacceptable behavior for your new animal?

What things or activities will you provide to amuse the animal?

References (required)

Reference1: Name Relation

Address
Phone Number

Reference 2: Name Relation

Address
Phone Number

Please check each of the following statements once the application has been completed and sign by typing your full name in the Signature field below.

I certify that the information provided is complete and correct to the best of my knowledge and I understand that false information may void this application and result in forfeiting the adopted animal. I give my permission and authorization to APAWS to contact my veterinarian and/or other references for further information, if desired. I also understand that APAWS adoption policy requires that I be called and/or visited for follow-up at any time after the date of adoption. I understand that APAWS reserves the right to deny any application for any reason. This is only an application for the animal, and a contract must be signed by me and an APAWS representative before the adoption is completed.

I understand that submitting this application does not guarantee that I will receive an animal from APAWS

Electronic Signature: Type in your full name (required)

Date