PFLR Adoption Application

PAWS for Life Rescue Adoption Application
Name of Pet to adopt*
Your Name*

First Name Last Name
Birthday*

MonthDay Year
Home Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone

Area Code Phone Number
Mobile Phone*

Area Code Phone Number
E-mail*
Employer*
Occupation*

Spouse / Partner

First Name Last Name
Other household members: name, gender, age (one per line)
Have you ever owned a pet?*
List pets you currently own by species / gender / spayed / neutered
Anyone in the household allergic to animals?*
Will you pay to transport your pet if necessary?*
Your living situation*
Can you provide proof that your landlord or HOA allows pets?
How long have you resided at your current residence?*
Please provide photos of inside the residence or where the pet will be kept

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Do you have a fully fenced in yard?*
Please provide photos of the outdoor space conditions with fence or walls

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Where will you keep your pet reside during the day-time?*
How many hours will the pet be left alone daily?*

Where will your pet sleep at night?*
Where will your pet spend his/her time when alone?*
Do you plan to use a crate?*
What will you do if your pet is destructive when left alone?*
Are you willing to attend obedience training with your pet?*
Have you ever surrendered, sold, or given away your pet to an animal shelter or rescue group?*
If Yes, Why?
How will you care for your pet during overnight family absences and vacations?*
What type/brand of food do you plan to feed your pet?

Has anyone in your immediate family or household ever been convicted of a charge related to cruelty to animals or child abuse?*
Are there any charges pending now?

Who is or will be your regular veterinarian?*
Veternarian Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Veternarian Phone Number

Area Code Phone Number

Please provide 3 References PAWS for Life Rescue may contact
Reference 1 Information*

First Name Last Name
Area Code Phone Number
Reference 2 Information*

First Name Last Name
Area Code Phone Number
Reference 3 Information*

First Name Last Name
Area Code Phone Number
Do you have any more information you would like PAWS for Life Rescue to consider in reviewing your application?

Read and initial the following:
I agree that all information on this application is true.*
I consent to verification of all the information I provided in the adoption application by Cynthia Merriman or by a Paws for Life Rescue representative.*
I agree to provide proper shelter, nutrition, regular veterinary care, emergency care when needed and a safe environment for the life of the pet.*
I agree to keep this pet as a companion and to devote the time necessary to provide for its comfort, safety, and happiness.*
I agree if I cannot keep this dog, I agree to return it to PAWs for Life Rescue (808)283-8828.*
I agree to allow for a minimum 30 day adjustment period. This is crucial for the animal to adjust to its new environment and family. All adopters should be prepared to give the animal proper training and guidance as you both get to know each other. (All dog adopters are encouraged to enroll in basic obedience classes, which are oﬀered at a discount for dogs adopted from us). All adopters are encouraged to call us with any questions or concerns regarding their newly adopted pet. Animals will be placed as companion animals only. They are to be accepted as family members, getting proper nourishment, medical care and attention. Adopters must be financially able to provide for the animal’s needs, including food, supplies, licenses and veterinary care. Be certain that you have adequate time to spend with you new pet, including time for training, exercise and grooming. Continuous confinement without adequate exercise or human interaction in not acceptable.*
I agree that this animal can be reclaimed from my property if I fail to comply with the agreed terms outlined in this application and verbal agreements.*
Should I fail to carry out the agreements I have made as part of this contract, or should any of the statements I have made be found to be false, I agree to surrender the dog/puppy adopted through Cynthia Merriman and or PAWS for Life representatives upon demand.*
If you surrender the animal to anyone but Paws for Life, you will be contacted for the costs incurred to retrieve the animal and will no longer be welcome to a Paws for Life animal.*
Adoption Fee: $150.00- $300.00 adoption fee. This helps cover the cost of medical examinations and care to date, spaying or neutering, appropriate vaccinations, heartworm testing, insertion of microchip and deworming.
I agree to pay the $150.00-$300.00 fee at the time of adoption. I understand that if I need to return the dog, all but a $50.00 donation will be refunded. PAWS for Life is an all-volunteer organization; we may ask that you keep the dog with you in your home, until a foster home can be arranged or until the next adoption event day.*
If your pet gets ill within the FIRST 5 DAYS you must notify us to find out what steps need to be taken. If you do not want to responsibility of caring for this animal, please return it immediately.

As a reminder to all of our adoptive families, as stated in our adoption application and contract, if for whatever reason you are unable to keep your adopted dog, it is required that the dog be returned to us.

Let’s be understanding of what these beautiful animals have been through. The commitment and mission of our foundation is to ensure that these dogs go to great forever homes. By returning them to us, we will be able to screen potential new homes for our dogs.

Thank you for your cooperation and support
Todays Date*

MonthDay Year
I have read the above and agree to adopt the dog under the agreed written and Applicant Signature*
Should be Empty:

PAWS for Life Rescue Adoption Application