DOG’S NAME*: DATE*:
PLANNED PETHOOD, INC. PLACEMENT APPLICATION
We reserve the right to refuse any applicant. You must be 18 years of age to apply. Submitting an application does not guarantee you adoption of an animal. This is only the first stage of the adoption process. We do not adopt out on a “first come, first serve” basis nor do we hold dogs.
We prefer the entire family to be present during the adoption process.
PLACEMENT FEE FOR ALL DOGS/PUPPIES IS NON-REFUNDABLE
applicants' initials here*: spouse:
1. How did you hear about us? www.petfinder.com www.plannedpethood.org Newspaper Veterinarian Friend or family Stopped by event Television or radio Humane Society or Dog Warden referred Other:
2. Why do you want to adopt this dog?*
3. What type of dog are you looking for?*
4. Why do you want this breed?*
5. Who made the decision to adopt a dog?*
6. On a scale of 1-5 (with 5 being highly energetic and 1 being very quiet) what activity level are you looking for?* 5 (high) 4 3 2 1 (low)
7. How many hours will your new dog be home alone?*
8. Where will you keep your new dog when home alone?*
9. Where will your new dog sleep?*
10. What % of time will your new dog spend inside*? % Outside? %
11. Do you realize this dog may be housebroken in the foster home but relapse at your home?
Yes No
12. What type of house training techniques will you use?*
13. What do you think is reasonable for food, supplies, grooming, vet care, etc. to cost monthly?*
14. Please enter age and type of pets you currently have in your household below:
Name/Age
Dog/Cat/Other
Spayed/Neutered
Indoors/Outdoors
15. Where do your current pets sleep?
16. Where do your current pets stay when home alone?
17. Under what circumstances do you think it is OK to let a dog outside unattended?*
18. What type of ID do you have on your current pet(s)?
19. How many pets have you owned in the last 5 years?*
20. Where are those pets now?
21. What in your opinion would constitute a prime reason for giving up a pet*?
22. What type of behavior problems have you had with previous pets?
23. Suppose your pet develops a frequent urination problem at age 12. You work 8 hours a day & they can’t hold it that long. What would you do?*
24. Have you ever given away a pet?* YES NO IF YES , please explain:
25. Has a dog ever died on your premises of disease or unknown causes?* YES NO IF YES , please explain:
26. Have you ever applied for a pet with another rescue?* YES NO IF YES, which group, how long ago, did you adopt, why or why not? Please explain:
27. Do you know what heartworm is? YES NO; IF YES , please state how dogs get heartworm disease.
28. How can heartworm be prevented?* YES NO
29. How do you plan on preventing fleas & ticks?*
30. Do you know what the parvo virus is and how it is contracted?* YES NO IF YES, please explain:
31. Do any family members have animal allergies?* YES NO IF YES, who is allergic and to what is the family member allergic to?
32. Will you take this dog to obedience classes?* YES NO Cost Estimate $
33. If you are dating or plan to marry someone who does not like or want your pet, what will you do?*
34. Do you:* Own Rent Apt. Mobile Home Condo ? If you do not own your home, please provide the name and number of the landlord, leasing company and/or condo association in the space provided. PPI cannot proceed with the application until of the landlord, leasing company and/or condo association is contacted. IF APPLYING FOR A DOG/PUPPY AT AN ADOPTION EVENT, PLEASE BRING A COPY OF YOUR LEASE.
35. How long have you lived at your current address?* If you have moved frequently, please explain why?
36. You have to move into an apartment/rental/nursing home/medical facility that does not allow pets. What would you do?*
37. Do you foresee any changes in your life in the next 15 years (average dogs life span), such as college marriage, new baby, children, moving, retirement.* YES NO IF YES, please explain:
38. Number of adults in household?* Relationship to you?
39. Number of children living in household*? Please list ages and gender below.
40. Do you have a fenced in yard?* YES NO IF YES, how high & what type?
41. If no, what will you do for the animal’s exercise and elimination requirements?
42. Please list your veterinarian’s name, phone # & clinic name as well as the name the account would be found under.*
43. Please list name, phone number & relationship to you of 3 personal references below*:
44. Would you object to a home visit by a representative of our organization?* YES NO
45. Do we have your permission to contact your vet and or references?* YES NO
By signing below, you are indicating that you have answered every question truthfully & are aware that any false answers will be grounds for immediate rejection. You also give Planned Pethood, Inc. permission to contact all personal references & your veterinarian, giving them permission to speak with us. We would like to thank you for your interest.
Signature of Applicant One*: Date*:
Signature of Applicant Two: Date:
Signature of PPI Agent: Date:
I understand the statements I have read about this dog are true based upon the foster evaluation of the dog. I understand that the dog might behave differently (negatively or positively) in my home. I understand that while the dog might be good with the current foster's dogs, cats, children, etc. it may not be with my animal (s) or children. I understand that the dog may be housebroken in the home of the foster but may relapse in my home. I understand the dog is represented to me as it performs in the foster home and any statements made regarding the dog are conditional to that foster home setting. I have read all the information about the dog and understand I cannot claim that I did not understand the facts about this dog as understood by Planned Pethood and/or the foster. I understand that the statements made regarding this dog are simply overviews and are not guaranteed. Furthermore, I understand that my adoption fee is non-refundable for any reason.
Agree Disagree
Revision date: April 2006