Protective Animal League
(PAL)

ADOPTION APPLICATION

This application is to assist in finding a matching family for PAL pets.  PAL may refuse placement of an animal for any reason.  Please provide all information as requested below or this will DELAY in processing your application. When submitting this application, you give permission for PAL to examine and verify the information that you provide.  All forms are property of PAL.

Personal Information

For security reasons please type "2468" in the field below before proceeding...

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First Name:       Last Name:    D.O.B.:  

Address:            Apt. #

City:                 State:     Zip Code:        

Home Phone:     Alt./Cell Phone:   

Email  Address: 

Employment Information

Employer:     

Address:  

Work Phone:

Spouse, Significant Other or Roommate

Name:

Relationship: - Spouse Significant Other Roommate Other

Employer:

Work Number:

How did you find out about this pet or adoption?     - Adoptapet.com Allen Petco Firewheel Petco Friend MySpace.com Petfinder.Com Plano Petco Richardson Petco Other - Please Specify Below

   If other please specify:

Are you interested in a cat or dog?

Cat  Dog

What is the name of the pet you are interested in?   

Why do you want to adopt a pet? Please check all that apply:

Companion for Child    Protection    Gift    

Companion for other pet    House Pet    Other

   If other please specify:

Do you have preferences as to breed, age, sex, length of hair, etc? - No Yes    

   If Yes please specify:  

Are you aware of heartworm disease? - Yes No

Household Information

What do you live in? - House Apartment Mobile Home Condo Other     if Other:     

Do you have a fenced yard? - Yes No

How long at current address? years    months    

Do you own your home? - Yes No

Do you plan to move within the next 12 months? - Yes No

   If yes, where?

If you rent-

     Amount of Pet Deposit   

     Is the pet deposit perpet or household?

     Is there a size/weight limit? - Yes No     If yes, what is the limit?

     Name of Complex or Landlord:     

     Phone Number:

Number of Adults in Household:     

Number of Children in Household:     Ages:

Do all adults in the household consent to this adoption?    - Yes No     

Are you or other adults in the household, a student? - Yes No

Do you or other adults in the household travel frequently? - Yes No     

If yes, how often?

Does anyone living in the house have allergies to: Cats? - Yes No     Dogs? - Yes No

Does anyone living in your house have asthma? - Yes No

Pet Ownership History

Have you ever adopted from a humane group or shelter? - Yes No

If yes, who did you adopt from?     

When?

Have any pets in your household been diagnosed with infectious diseases in the last 6 months? - Yes No

If yes, what disease/condition?

Name of your veterinarian/clinic:   

"Please note that by giving us your Veterinarians information you are hereby giving PAL your permission to obtain all of your current and past pet histories.
Please initial here to confirm that you understand and approve of this action... "

Phone Number:         

Total Number of pets CURRENTLY owned:

Dogs    Cats    Other

Total number of pets in the last 5 years NOT CURRENTLY owned: 

Dogs    Cats    Other

    Type: - Cat Dog Other     Breed:     Sex: - M F     

    Age: yrs    Length of Ownership: yrs

    Do you own the pet now? - Yes No     

    If no, what happened to it?

    Was/Is it spayed/neutered? - Yes No

    If the pet was a cat, was/is it declawed? - Yes No
 

    Type: - Cat Dog Other     Breed:     Sex: - M F     

    Age: yrs    Length of Ownership: yrs

    Do you own the pet now? - Yes No     

    If no, what happened to it?

    Was/Is it spayed/neutered? - Yes No

    If the pet was a cat, was/is it declawed? - Yes No
 

    Type: - Cat Dog Other     Breed:     Sex: - M F     

    Age: yrs    Length of Ownership: yrs

    Do you own the pet now? - Yes No     

    If no, what happened to it?

    Was/Is it spayed/neutered? - Yes No

    If the pet was a cat, was/is it declawed? - Yes No
 

    Type: - Cat Dog Other     Breed:     Sex: - M F     

    Age: yrs    Length of Ownership: yrs

    Do you own the pet now? - Yes No     

    If no, what happened to it?

    Was/Is it spayed/neutered? - Yes No

    If the pet was a cat, was/is it declawed? - Yes No
 

    Type: - Cat Dog Other     Breed:     Sex: - M F     

    Age: yrs    Length of Ownership: yrs

    Do you own the pet now? - Yes No     

    If no, what happened to it?

    Was/Is it spayed/neutered? - Yes No

    If the pet was a cat, was/is it declawed? - Yes No
 

I confirm that all of the information in this application is correct and complete to the best of my knowledge. By entering your name in the signature box below you are certifying the validity of this document.

Adoption fee must be paid by check or cash only.

Signature:     Date:

"Altering the World, one pet at a time."