Online Pet Adoption Form
Email address *
Name of Applicant *
Your answer
Date *
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YYYY
Age of Applicant *
Your answer
Name of Desired Pet
Your answer
Type of Pet *
Residential Address (NO Post Office Box) *
Your answer
Phone Number *
Your answer
Place of Employment *
Your answer
Occupation *
Your answer
List All Members of Household (include ages) *
Your answer
List all domestic animals living in your household. (Include type, age, sex, and spayed / neutered status) *
Your answer
Do your current pets live in doors?
Your answer
If your current pets do not live indoors, please describe the protection from the elements you provide:
Your answer
How did you acquire your current pets
Your answer
Please list all pets you have had in the last 5 years that no longer live with you and where they may be now.
Your answer
Why do you wish to adopt a pet *
Your answer
Have you ever had an application for a pet denied from an animal welfare group / animal control facility? If yes, please explain. *
Your answer
Are you willing to take the time to house train a dog and do you understand that changing a dog or cat's environment may cause the pet to have accidents?
If a behavioral problem arises, what steps will you take to remedy it? *
Your answer
Does any family members living in the home have known allergies to animals? *
Describe the kinds of personal situations where you might have to return your adopted pet; (i.e. job loss, children, move, marital change, etc.)
Your answer
Who in the household will be responsible for taking care of the pet? *
Your answer
Please list the veterinarian(s) that have provided care for your current or previous pets, as well as their phone numbers. *
Your answer
Under what owner name would the your vet records be listed?
Your answer
What type of dwelling do you live in *
Do you own or rent your residence *
If you rent, please provide landlord's name and phone number. *
Your answer
Do you have a fenced in yard? If so, what type of fencing do you have? *
Your answer
For those wishing to adopt dogs, how much time a day do you plan on excising them?
Your answer
Please indicate where you will keep the pet when someone is home and when no one is home *
Your answer
When you travel, what arrangements will be made for your pet? *
Your answer
How often do you typically travel?
Your answer
If you move, what arrangements will be made for the pet? *
Your answer
Have all adult family members agreed to adopt a pet? *
Authorizations:
By signing, I agree:
I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application may result in delayed processing of the application. I give APAC permission to verify the information provided as well as contact veterinarians and other listed contacts. If the application passes this review, I understand a home and yard visit may be requested by APAC before an adoption decision is made.
In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received for this animal.

Electronic Signature and Date: *
Your answer
Electronic Signature and Date *
Your answer
Medical Release Authorization: By way of my electronic signature and date below, I hereby authorize the vet(s) listed above to release any and all medical information on any and all pets listed under my name for the sole purpose of determining my eligibility to adopt a pet from Angel Paws Adoption Center. *
Your answer
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