Date of Birth (PAWS cannot adopt to anyone under 18 years old)*
Full Address (include city, state, zip code)*
E-mail Address*
Home Phone*
Cell Phone
Alternate Phone
Which pet are you applying for? (name or description)
Are you:
Employed   Student   Retired   
Type of Residence:
House   Apartment   Mobile Home Office   
Own   Rent   
If you rent, does landlord allow pets?
Yes   No   
Landlord's name
Landlord's phone number (will be verified by a PAWS representative)
What times would be best for a PAWS representative to call or visit?
Do you plan to move in the near future?
Yes   No   
If you move in the future, will you be able to keep your pet(s)?
Yes   No   
Are other family members aware you plan to adopt a pet?
Yes   No   
Life style:
Extremely Active   Moderately Active   Somewhat Active   
Not Active   
Are you?
Single   Married   Live with parents   
Couple, not married   Military   
Number of adults in household
Number of children at home
Ages of children
Currently have pets
Yes   No   
How many dogs
How many cats
How many other
Spayed or Neutered
Yes   No   
   If not, please explain
Current on shots
Yes   No   
   If not, please explain
What kinds of pets have you had in the past?
What happened to your last pet?
Have you ever lost a pet due to:
Poisoned   Hit by Car   Disease   
Stray/Stolen   Old Age   
Have you ever had to give up a pet?
Yes   No   
If Yes, why?
Have you ever gotten a pet or applied for a pet from another humane organization for an adoption?
Yes   No   
lf Yes, when?
What organization?
Is anyone in your family allergic to animals?
Yes   No   
Name of Current Veterinarian (if applicable)
Phone number
Other personal reference (name and phone number)
Are you prepared and willing to meet the yearly costs of regular preventive care, possible additional vet care, and everyday food, supplies and training costs for your new pet? Estimate $150 - $250
Yes   No   
Your pet will live:
Indoor   Outside   Combination of both   
If outside, what kind of shelter and confinement will be used?
Do you plan to use a kennel?
Yes   No   
How do you plan to housetrain?
Do you feel willing and able to work with your pet and correct problem behavior if it should develop? (examples - destructive, jumping, chewing, bathroom issues, etc.)
Yes   No   
What are your ideas for dealing with such behavior?
Who will be responsible for your new pet's care?
About how many hours a day will your pet be alone?
About how many days a week will your pet be alone?
Where will it be kept when left alone?
What type of I.D. do you plan to have for your pet?
Both PAWS adoption policy and Iowa law (for pets from pounds and shelters) require that adopted animals be spayed or neutered. Do you agree with this?
Yes   No   
Are you prepared to give your new pet plenty of time to adjust to its new home?
Yes   No   
PLEASE NOTE: If applying for a cat, whether your cat will live inside or outside, we strongly oppose declawing cats. Declawing a cat is the equivalent of cutting off a human’s finger at the first knuckle. Do you agree to NOT declaw this cat?*
Yes   No   
Has a trial home visit been discussed with you by a PAWS representative?
Yes   No   
What is your reason for wanting to adopt a pet?
Would you consider adopting two animals for companionship - especially if home alone often?
Yes   No   
I certify that the information I have given is true and authorize investigation of all statements made above. I understand that PAWS has the right to refuse any request for adoption.  Adopter's name