Pre-Adoption Application

PUP & CAT CO.

A HUMANE SOCIETY

P. O. Box 1987

Winder, GA 30680

(770) 867-1622 phone

 

www.pupandcatco.com
     

We request that you provide to us the following information so that we may better insure that the pet you wish to adopt will be best suited to you, your home & lifestyle, and also to ensure that the pet will be placed in an environment that will be most compatible with its needs. We may take several applications on an animal.  If you are approved a member of PAC will contact you.

PAC has the right to refuse any applicant.
Pet's name:  



Dog



Cat

Your name (Print):

  

Street Address:

                                                                    City                              State             Zip

Phone Number:

(Home)

  

(Work)

  

(Cell)

  
Email Address:          

Do you:       Own       Rent - If yes, does your lease allow pets?    ( ) Yes     ( ) No.   If yes, list landlord, apt.

complex name & phone Number:

        
Do you:       Work    ( ) Work at home     ( ) Stay at home     ( ) Retired       Attend School
Do you have:       Fenced yard and is it completely fenced  ( ) Yes  ( ) No.          Type of fencing  ( ) chain link
( ) wooden privacy     ( ) cattle wire     ( ) wrought iron     ( ) other.                Height  ( ) 8 ft.  ( ) 6 ft.  ( ) 5 ft.  ( ) 4 ft.
  Fenced run/pen and dimensions:     ( ) Tie Out.
Do you currently have any pets  ( ) Yes    ( )  No              Type of pet(s)  ( ) Dog     ( ) Cat
Spayed/Neutered  ( ) Yes ( ) No.  Up to date on shots  ( ) Yes ( ) No.  On Heartworm and Flea Preventative  ( ) Yes ( ) No.

Please list all pets you have had in the last five (5) years:

Breed/Type

Kept Where?

Still Own?

If no, where is it?

Spayed/Neutered?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What size pet do you want?

  Small

  Medium

  Large

   Any size  

Will the pet be:    Indoor and how will it be kept     ( ) crated   ( ) free roam   ( ) gated area.        Outdoor
  Both.     If both, how much time indoors ____________ and how much time outdoors __________.
 
 
 
 
 
 
 
Please tell us why you would like to adopt a pet.  Check all that apply.

  Personal protection      Personal companion       As a gift       To breed       Watchdog       For a child

  Companion for other pet

Do you have children?   Yes   No   If yes, how many and what ages? ________________________________________

Do you plan to have children in the future?   Yes    No

How would you describe your household?   Busy      Quiet      Away from home a lot      Travel often

 Active      Other (please explain): ____________________________________________________________________
 

Does anyone in your household have allergies?         Yes      No

Have you ever adopted from us before?      Yes      No

If yes, when and what type of pet did you adopt?

  

Are you familiar with the animal control laws in your area?         Yes       No

Have you ever been cited for a violation of the animal control laws?         Yes      No

If yes, what were the circumstances? _____________________________________________________________________

Will you use a leash to walk or exercise your dog?         Yes      No

How many hours per day will your pet be left alone?

  

How will the pet be kept while you are away?

 

If you have a pet now, WHO IS YOUR VET?

 
I authorize Pup & Cat Co. to contact the veterinary clinic named above to confirm the medical records/history
of my pets.      Yes       No

What type of HEARTWORM PREVENTATIVE do you use?

 

What type of FLEA CONTROL do you use?

 

What will you do with your pet if you move?

 

Realizing that dogs and cats often live 15 years or longer, are you willing to take responsibility for your pet's entire life, keeping it current on yearly shots and tests?

 Yes      No

Are you willing to keep a dog on heartworm preventative?    Yes       No
Are you willing to use effective flea control products?      Yes      No
Would you be willing for a representative of our organization to do a home visit both before and after
adoption?      Yes      No
How much do you estimate the cost of caring for a dog/cat is yearly?  __________________________________________
Who will be responsible for the care of your new pet?  
 
 
 
 
 
 

Will you decide to alter your pet's appearance other than normal grooming (De-claw, dock tail, crop ears)?
 Yes      No     Please explain:  _______________________________________________________________________

How do you feel about spaying and neutering?

 

Are you prepared to make a lifestyle adjustment to provide this animal a forever home?   Yes      No

Does everyone in the family agree to adopt a pet?      Yes      No

Under what circumstances do you think it would be wise to find a new home for a pet?  ____________________________

 

Are you willing do deal with an adjustment period and to work through behavioral problems?

 Yes      No
Are you willing to take your pet to obedience training?    Yes      No

Would you be interested in making future donations to Pup & Cat Co.?         Yes      No

Would you be interested in becoming a volunteer with Pup & Cat Co.?         Yes      No

Would you be interested in becoming a foster family for a dog or cat?          Yes     No

 

By signing the line below, I certify the information I have given is true and that any

misrepresentation of facts may result in my losing the privilege of adopting a pet or of keeping the

pet after adopting.

 

 

Signature:

  

Date:

  
       
       
       

Have a Heart.....Adopt a Homeless Pet

 
 
 
6/15/07