Dog Adoption Application Pet Assistance League (PAL) of Virginia P.O. Box 1076 * Stafford, VA 2255...

Dog Adoption Application Pet Assistance League (PAL) of VirginiaP.O. Box 1076 * Stafford, VA 22555 * (540) 659-5018 A successful adoption depends on both selecting the right animal for your household and understanding that animal"s needs. We want to help find the best pet for you and the best home for the pet, so please answer the following questions completely and honestly.

Name of dog interested in:*
Date:*

MonthDayYear
Date
Name:*
Home Phone Number:*
Address:*
Alternate Phone Number:
City:*
State:*
Zip Code*
Email Address:*
Living Arrangements*

OwnRent
Residence Type*
If you rent, are pets permitted on your lease?

YesNo
Weight Limit:
Landlord Name, Address & Phone:
Is your yard fenced?*

YesNo
If not, is a fence planned?

YesNo
If yes, please describe type of fence and height.
Number of adults in house:*
Children:
Ages:
In future?
List any pets you have owned in the past five years: (If more than 5, please send additional pets" information via email to adoptions@pal-va.org.)
Type:
Breed:
Sex
Spayed/Neutered

YesNo
Where is the animal now?
How long has it been with you?
Type:
Breed:
Sex
Spayed/Neutered

YesNo
Where is the animal now?
How long has it been with you?
Type:
Breed:
Sex
Spayed/Neutered

YesNo
Where is the animal now?
How long has it been with you?
Type:
Breed:
Sex
Spayed/Neutered

YesNo
Where is the animal now?
How long has it been with you?
Type:
Breed:
Sex
Spayed/Neutered

YesNo
Where is the animal now?
How long has it been with you?
Are all of your pets currently up-to-date on all vaccinations?

YesNo
If no, please explain:
Will you insure that you dog gets regular medical checkups and required vaccinations?*

YesNo
Do you authorize a vet check by a PAL representative?*

YesNo
Name & Phone Number of Veterinarian:
Have you ever had to give up a pet for any reason?*

YesNo
If yes, what were the circumstances?
Do you currently have or plan to have a doggie door?*
How many hours will your dog be alone during the day?*
Where will your dog be kept when alone?*
Where will your dog be kept when you are home?*
Where will your dog sleep?*
Will your dog be tied out in the yard?*

YesNo
Will you allow the dog to ride in the bed of a pick-up truck?*

YesNo
How much time do you realistically have every day to exercise and play with your dog?*
Who will care for your dog when you go on vacation?*
What plans do you have for disciplining and training your dog?*
Will your dog be allowed outside unattended when you are not at home?*

YesNo
Why do you want this dog? What about this dog appeals to you most?*
Do you agree to spay or neuter this dog (for puppies) at six months and provide proof to PAL?

YesNo
Does anyone in the household have animal allergies?*

YesNo
If yes, please explain:
Who will be the primary caretaker of this dog?*
Is everyone in the household aware of this adoption and in complete agreement with it?*

YesNo
If no, please explain:
What age appeals to you most?*
What will you do with this dog if you can no longer keep it?*
If you selected "Other" please explain:
What circumstances, in your mind, justify giving up a dog? Please check all that apply.*

MovingNew babyNot getting along with other petsDivorceToo time consumingGetting out of fenceBehavioral problemsChildren lost interestAnimal gets too bigSheddingAllergiesHousebreaking problemsMedical ProblemsAggressionOther (Explain below)
If you selected "Other" please explain:
If your dog later develops a medical problems that becomes expensive, what will you do?*

Find the dog another homePay whatever it takesHave the dog put to sleepGive the dog to a rescue group or shelterOther (Explain below)
If you selected "Other" please explain:
Do you understand that this dog may not be housebroken, and are you willing to take the time to work with this dog?*
How much do you think it will cost annually to care for this dog? (Food, vet bills, toys, etc.)*
Will you allow PAL to visit your home prior to and after the adoption?*

YesNo
If no, please explain:
Will you allow PAL to periodically inquire about the dog"s welfare and living conditions?*

YesNo
If no, please explain:
Please provide any other information you think may be helpful to PAL here:
In order to help defray expenses and help other PAL animals, there will be an adoption fee of $250 to $300. For puppies under six months old, once proof that spay or neuter has been performed at approximately six months of age is provided to PAL, $50 will be returned to the adopter.
MY ELECTRONIC SUBMITTAL OF THIS APPLICATION INDICATES THAT I HAVE ANSWERED THESE QUESTIONS HONESTLY, AND TO THE BEST OF MY ABILITY. i AGREE TO THE TERMS AND CONSIDERATIONS SET FORTH IN THIS ADOPTION APPLICATION. I UNDERSTAND THAT ANY MISREPRESENTATIONS OF FACT MAY RESULT IN THE REMOVAL OF THE ADOPTED PET FROM MY HOME BY PAL.
Date application completed and submitted:*

MonthDayYear
Date
Should be Empty: