Fill and Sign the Bir Form 1904

Adoption Application Papillon Pals Rescue, Inc. P O Box 350992, Jacksonville, FL 32235 Email: adoption@papillonpalsrescue.com To help ensure the best possible placement of our rescued animals, and in order to determine that the proposed adoption is in the best interest of first and foremost the animal, yourself, and your family, please complete each of the following questions. Please be as thorough as possible. Due to the amount of applications we receive daily PPRI reserves the right to refuse adoption to any application that is not completely filled out. After completing this form please email or mail to PPRI. Thank you. What is the name of the dog you are inquiring about? Date: First Name: Last Name: Birthday: Street Address: City, ST, ZIP: County: Home Phone: Work Phone: Cell: Email Address: How many adults in the household? Please list their names, ages and occupations: Name Age 1. Occupation 2. 3. 4. How many children in the household? Please list their names and ages: Name 1. Age 2. 3. 4. Do grandchildren, nieces/nephews or other kids ever visit? Do any family members suffer from allergies? How are the allergies treated? Are the allergies to animals? Who will be the primary caregiver for the new dog? Does this person work away from the home? How many hours per day will the dog be left alone? Please explain in detail how new dog will be secured when left home alone. How long at current address? Is it a house, condo, apartment or other (please specify)? Do you own or rent? If you rent, please provide the name and phone number of the property owner: Name Phone Number Do you have a securely fenced yard? If so, what type of fence is it (wood, chain link, block wall, etc.)? If your fence is not solid, how much space is between pickets or boards? How high is the fence? What are the approximate dimensions of the fenced yard area? Is there a doggie door leading to the yard? How long will you leave this dog outdoors unsupervised? If you have no fence, where and how often do you plan to take your dog to potty? Will the dog be on a leash? Under what circumstances would you allow your dog to be off-leash? Are there any areas of the house where the dog will not be allowed? If so, how will you keep the dog out of them? Will the dog be allowed on the furniture? If not, how will you keep it off the furniture? Will the dog be given the run of the house when no one is at home? Where will the dog sleep? Will you use a crate for your new dog? If yes, when and for what reasons? Have you ever trained a dog to respond to simple commands? If so, how would you describe the method you used? Does anyone in your household have any special training or experience in dog-related fields? (training, grooming, vet tech, etc.) How will you discipline your new dog for undesirable behavior? Barking? Marking in the house? Chewing inappropriately? Growling? If your new dog is not housetrained, how will you housetrain it? Are you aware that even housetrained dogs need a period of adjustment in a new home? What will you do if the dog has “accidents” in the house? List all animals that currently live at your home, including pets and farm animals: Dog/Cat & Name 1. Breed Spayed/Neutered (Y/N) Indoor or Outdoor Age & Weight 2. 3. Advise general temperament of each animal inside the home and canines and felines outside of the home. List all present and past pets you have been responsible for as an adult: Dog/Cat Spayed/Neutered Indoor or Date & Name Breed (Y/N) Outdoor Deceased 1. 2. 3. 4. If animal is living and not in your possession, why not? If animal is deceased, what happened? If you have a cat(s), describe how you hope your new dog will interact with it: How do you intend to exercise your new dog? Do you have what you consider an active lifestyle or are you more the couch potato type? Do you travel a lot? When you go out of town, what arrangements will you make for your rescued dog? Have you ever adopted a rescued dog/cat before? Do you belong to any animal rescue groups? If so, which groups and what type of animals are rescued. Do you foster animals for these groups? Why do you want a dog (or another dog) at this time? Why do you want a rescued dog? What characteristics do you especially want in your new dog? What characteristics do you not want in your new dog? What will you do if your new dog has some unwanted characteristics? What is the age range of the dog you hope to adopt? What sex and why? How important to you is it that the dog already be housetrained? Are you willing to adopt a special needs dog? (deaf/blind/requires medications)? Are you aware that toy dogs can be big barkers? What will you do if your rescued dog barks a lot? Please provide the name and phone number of your current or previous veterinarian: Name Phone Number Please provide the name and phone number of your groomer (if applicable): Please provide the names and phone numbers of two personal references, not including family members who have visited your home: Reference Name Relationship Phone Number 1. 2. Is there anything else that you would like us to know about you and/or your family? Have you applied to adopt a dog with another rescue? If so, what is the status of your application? Have you applied to adopt a different dog from Papillon Pals Rescue? Do you agree to have a representative of Papillon Pals visit your home prior to adoption? Do you agree to a follow-up visit after adoption? Do you agree to pay an adoption donation of $100-$600, depending on the dog’s age, health and possible special needs? If anything were to happen to you that would prohibit you from keeping the dog, do you understand that a Papillon Pals Rescue must be notified and the dog must be returned to us? Do you understand that the amount designated as an adoption donation is just that—a donation. When is dog is returned adoption donation is not refunded. There may be special exceptions to this rule. These exceptions will be reviewed and determined by Papillon Pals Rescue’s Board of Directors and all decisions are final. Thank you for completing this application and thank you for wanting to give a forever home to one of our rescued dogs! I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Papillon Pals Rescue, Inc. (PPRI) reserves the right to annul the adoption and reclaim the animal. I give Papillon Pals permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a Papillon Pals volunteer before an adoption decision is made. In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal. I understand it is the Papillon Pals prerogative to decide which home is most appropriate and that their decision is final, and therefore I will not argue with the decision. Unless otherwise indicated by Papillon Pals, I am free to apply and undergo the application process in the future. __________________________________ Applicant Signature ___________________ Date Typing in your name on this document if it is sent via email constitutes a legal signature. __________________________________ Please Print Your Name Here (Print if you are mailing to PPRI) If you so choose you may download this document, complete it and email to: adoption@papillonpalsrescue.com Or print, complete and mail to: Papillon Pals Rescue, Inc, P O Box 350992, Jacksonville, FL 32235 A 501(c)(3) public charity incorporated in the State of Florida