POWERful Paws Animal Rescue Adoption Application
All applicants must be at least 21 years of age or older. Please understand that applicants are not on a first come first serve basis. Approval is based on what will be the best for the pet and the applicant.
First Name
Last Name
Phone Number
Number of Adults in the Home
Number of Children in the Home
Clear selection
Do you live in a:
Clear selection
Is there a particular dog you are Interested in?
Please list any pets you own, including their names, breed, age and whether or not they are spayed/neutered:
What breeds of dogs have you/your children lived with?
Tell us about the pets you have had in the last 10 years:
Describe your home environment in 5 words or less:
Do you have a fenced in yard?
Clear selection
If you do not have adequate fencing (i.e. a totally enclosed, secure fence) how will you provide security and safety for your pet while outside?
Please explain why you want to adopt this animal:
Clear selection
Please describe your level of experience in pet ownership:
On average, how many hours per day will your pet be left alone?
Describe what life would be like for a pet that joins your family:
What provisions would be made for your pet if left alone during the evening?
What provisions would be made for your pet when you go on vacation?
Under what circumstances would you give up a pet?
Have you ever had a pet lost or injured? If yes, please explain:
Are you willing to take responsibility for this pet for the next ten years or more?
Clear selection
How much do you think it will cost to take care of this animal each year? Please consider the cost of veterinary care, food, grooming, toys, licensing, etc.
If you currently owned or have recently owned a pet in the last two years, please list your veterinarian's name and phone number. ***After submitting this application please contact your veterinarian and give them permission to release records to the rescue. We cannot move forward with the application unless this step is completed***
If you rent, please provide landlord's name and phone number:
Personal Reference 1 - Name and phone number
Personal Reference 2 - Name and phone number
A home visit may be required by a representative of PPAR prior to a final decision: (Please initial below)
I certify that that the above information is true and correct to the best of my knowledge. I also acknowledge falsification of the above can result in my being denied adoption of an animal. Any veterinary problems that may arise post-adoption, including serious illness requiring emergency care or surgery, are your responsibility and you are responsible for all related costs. I understand PPAR reserves the right to refuse adoption to anyone. Adoption approval and refusal decisions are made solely at the discretion of POWERful Paws Animal Rescue. (Please initial below)
Electronic signature and date
Co-applicant electronic signature and date
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