Paws Illinois
OUR MISSION
DONATIONS
REQUESTED FORMS
HELPING PETS 4 VETS
PAWS ILLINOIS RESCUE
VOLUNTEER
MEDIA EVENTS
CONTACT US
PAWS GENERAL STORE
APPLICATION FOR CANINE ADOPTION
*
Indicates required field
Date
*
Name of dog desired (if known) or general description
*
Breed/Color
*
Have you or anyone in your home been convicted of a felony?
*
Have you or anyone in your home ever been charged or cited for any cruelty or neglect towards animals?
*
If interested in a pit bull/bully breed are you legally able to own one?
*
Applicant Information
Name
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Telephone numbers
Home
*
Work
*
Cell
*
Email
*
Date Of Birth
*
Number of People in Household
*
If children are in the household, please list ages
*
Are you or any member of your family allergic to pets
*
Yes
No
Are you presently
*
Employed
Unemployed
Retired
Student
Name of Employer and Phone Number
*
Co-Applicant Information
Name
*
Relationship
*
Telephone numbers
Home
*
Work
*
Cell
*
E-mail Address
*
Date of Birth
*
Are you presently
*
Employed
Unemployed
Retired
Student
Name of Employer and Phone Number
*
General Information
Type of residence
*
House
Apartment
Condo
Mobile Home
Farm/Barn
If rental, are dogs allowed?
*
Yes
No
Size Restrictions?
*
Yes
No
Any Breed Restrictions?
Max. Size
*
How Long at this Address?
*
If Renting, Landlord's Name and Phone Number
*
Current housing location
*
City Limits
Outside City Limits
Phone Number
*
Type of street
*
Very busy road
Slight traffic
Residential area
Country road
Where will dog live?
*
Inside only
Outside only
Mostly inside
Mostly outside
Where will the dog spend nights?
*
Inside
Outside
Do you have a fenced yard ?
*
Yes
No
If answering yes for a fence, what is the fence's height?
*
What type of fence material?
*
Chain Link
Wood
Vinyl
"Invisible"
If Yes, where?
*
How many hours per day will the dog be alone?
*
Where will the dog stay when left alone?
*
Describe the activity level in your home
*
Busy (visits by friends, meetings, children, parties at home)
Noisy (TV, stereo, machinery, tools, children playing, dogs barking)
Moderate (Normal comings and goings)
Quiet (homebodies, few guests)
Seldom Home
Young children in home or visiting regularly
In the absence of the primary caregiver, who will care for the dog?
*
Under what circumstances would you return the dog to us?
*
New Job
Divorce
New Baby
Move
Illness
Other – specify
Are you willing to take responsibility if this pet acquires an illness for tests positive for heartworms?
*
Yes
No
Are you willing and able to pay the veterinary costs of caring for your new pet?
*
Yes
No
Are you willing to take the time to work with a dog on housebreaking or chewing, if such problems arise?
*
Yes
No
Would you consider obedience training for your new dog?
*
Yes
No
Will you crate train your new dog? Do you own a crate?
*
Pet Information
Have you had pets in the last five years?
*
Yes
No
If yes, complete the following chart
Spayed/Neutered
Inside/Outside
Where is Pet Now?
Name/Type
*
Years Owned
*
Choose Any
*
Yes
No
Choose Any
*
Inside
Outside
Where is pet now?
*
Name/Type
*
Years Owned
*
Choose Any
*
Yes
No
Choose Any
*
Inside
Outside
Where is pet now?
*
Name/Type
*
Years Owned
*
Choose Any
*
Yes
No
Choose Any
*
Inside
Outside
Where is pet now?
*
Were your past pets kept up to date on vaccinations?
*
Have you ever abandoned or surrendered an animal to a shelter/rescue, police station, or person?
*
Current or past vet name of clinic
*
Phone
*
Do you consider your dog a part of the family?
*
Yes
No
Are you aware that a dog is a large and lifelong commitment?
*
Yes
No
Will your new dog be on heartworm prevention?
*
Yes
No
How did you hear about the PAWS ILLINOIS?
*
Personal Reference (Non-Family)
1 Name
*
First
Last
[object Object]
Phone
*
Years Known
*
Email Address
*
Please enter your full name and date here for electronic signature
*
Submit