Please complete the following application in its entirety, and submit it to a PAHS employee for verification.
Dog's Name*
Dog Adoption Form Download
Name*
Date of Birth*
Address*
City*
State*
Zip Code*
Home Phone*
Cell*
Work*
E-mail*
Place of Employment*
Todays Date*
Do you rent?YesNo
Landlord/lady's name:
Landlord/lady's phone:
How long have you lived at your present address:
If you move in the future, will you ensure the residence allows pets?YesNo
If needed, do you have approval to have a dog in your home?YesNo
Human Household Members
Age
How will they be involved in care?
-additional fields
Name of vet Clinic:
Phone #:
Do you have training or behavioral modification experience?YesNo
If so, elaborate:
Experience with:Resource GuardingDog AggressionChewingLeash ReactivityCage ReactivityAnxietyGeneral FearfulnessGeneral Command TrainingFear of StrangersJumpingLeash EtiquetteSocializingNippingHouse Training (peeing/pooping)
If not, are you able to put your dog in training classes?YesNo
If you are adopting a puppy, are you able to put then into puppy socialization classes?YesNoN/A
Describe where you will be keeping the dog(s), including how you will separate them from your own animals, if applicable:
Approximately how long, on an average day, will dogs be left alone in the home (without people to monitor eating, behavior and elimination)?
Previous experiences with animals:
Are you currently or have you previusly adopted from any other humane organization? If so, which one?
Have you ever surrendered a pet before?YesNo
If so, Why?
Anything else you would like to share about yourself or your experience?
Do you understand that: (check the box to indicate “yes”):The adoption fee can range from $175-$500The adoption of this dog requires her/him to be spayed/neuteredThe dog you are adopting may not be housebrokenYou take full responsibility for fully training your dogThis dog can live up to, if not more than, 15 yearsYou will be responsible for the veterinary commitment that your dog will require
Name:
Relation:
Address:
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