Paws Hoofs and Claws (PHC) Inc Adoption Enquiry Form
Which animal you are interested in adopting?
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Applicant's First Name:
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Applicant's Last Name:
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Street Address:
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City:
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State:
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Postcode:
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Email Address:
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Please enter correctly as this is the main way we will contact you
Mobile phone:
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Please provide an alternative contact person's name
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Please provide alternative contact person's phone number
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Are you over 18 years old?
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Yes
No
Type of employment
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Full-time
Part-time
Work from home
Home Duties
Other
Do you own other pets at the current time?
No
Yes
If yes, please list their names, breeds, and ages:
Are all of your pets spayed/neutered/fixed?
Yes
No
N/A
Have you ever had to give away, surrender or re-home a pet previously?
No
Yes
If yes, please explain?
Please check the main reason you plan to adopt a pet:
Companion
Family Pet
Child's Pet Guard Dog
Companion for another pet
Other
If you answered "other" above, please explain here:
Do you own or rent your home?
Own
Rent
Someone else owns the Home
Someone else rents the Home
Please select your current residence type.
House
Apartment
Condo
Townhouse
Mobile Home
Other
If you answered "other" above, please explain here:
How long have you lived at this address?
Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
If you rent, does your landlord and lease allow pets?
Yes
No
Unsure
N/A
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home:
Is everyone in your household aware that you are planning to adopt a pet?
Yes
No
N/A
Does anyone in your household have allergies to dogs/cats?
Yes
No
Possibly
N/A
Will this pet be predominantly living inside, outside, or both?
Inside
Outside
Both
Please provide a description of this pet's living conditions:
Do you have a completely fenced-in yard? If so, what kind of fence?
Colorbond
Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
If you answered "other" above, please explain:
Where will the animal sleep?
In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
If you answered "other" above, please explain:
What would you do with your animal if you had to move?
Take him / her with me
Give to family or friend
Return to shelter
Other
If you answered "other" above, please explain:
Will you allow us to perform home checks?
No
Yes
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am aware this is an adoption enquiry only and this does not guarantee me a pet.
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Yes
No