Online Adoption Application

First Name

Last Name

Date

Street Address

Mailing Address (if different than street)

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

Email

Age

I am interested in a:

Cat Kitten Dog Puppy

Name of animal (if applying for specific animal)

How did you hear about United Paws?

Rent / own

Rent Own Live with parents / relatives

Type of residence

House Apartment Condo Mobile home

Any other important info about your residence:

Landlord name (if applicable)

Landlord phone number

# of people in household

# of people under 18 (please specify ages)

List pets living with you in last 5 years (For each, please specify type, age, sex, neutered / intact, indoors / outdoors, whether still part of household)

Why would you like to adopt a pet?

Do you or your neighbors own livestock or exotic animals?

Yes No

How much do you expect to spend on your pet each year?

$100-$200 $200-$300 $300-$400 $400-$500 $500+

If you are approved for the adoption of a kitten or cat, are you considering having he or she declawed?

Yes No

Please check the topics you would like to discuss with us:

Indoor vs. Outdoor Feeding your new friend Vaccines and Flea control Pets and children Introducing a new pet to other pets Playing with your new friend Declawing Crate training for dogs Obedience/training classes for dogs

How do you plan to transport your pet home?

My new pet will be primarily

Indoors Outdoors Both

How many hours a day will your new pet be outside?

What kind of outdoor containment (fencing, etc) do you have available?

When I am not home my pet will be

Free in the house In a crate In the yard On a cable run In a kennel In the garage

In general, my pet will be without human companionship __ hours per day

less than 2 3 to 6 7-8 8+

(For potential adopters of dogs) What level of training are you willing to provide to your new dog to help improve manners such as pulling on the leash or jumping

No training Some training Significant training including classes

(For potential adopters of dogs) Are you interested in adopting a dog with special needs, either medical or behavioral?

Yes No

Reference #1 (include name, relationship to you, and phone number) - Please note: all 3 references are required, and only ONE may be from a family member NOT living with you

Reference #2 (include name, relationship to you, and phone number)

Reference #3 (include name, relationship to you, phone number)

Current or past veterinarian (include name of vet, clinic phone number, and names of pets cared for)

Submit

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