Animal Adoptation Form Name of Animal to Adopt Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home / Cell PhoneWork Phone(Required)Email Are you 18 or older? Yes No I have a current & valid State and Government ID What is your profession? Are you currently employed? Name and Address of Employer What is your annual income for 2024 and current monthly income? Number of adults in your household? What are their ages? Number of children in your household (if any)?01234567+What are their ages? Do you own or rent you home?OwnRentIf renting, do you have permission to have pets? Yes No If there are restrictions on number/breed/size of animals, please explain:Landlord's name and phone #:Describe your yard: No yard Unfenced Partly fenced Completely fenced Fence height at its lowest point. List by feet Fence is made of: Chain Link Wood Cinder Block Other How big is the fenced area of yard? Does anyone in your household have allergies that could affect the animal? Yes No Do you presently own pets? *(Required) Yes No If yes, please list breeds & ages:Are these animals spayed/neutered? Yes No If no, why not?Are your pets current on vaccinations?YesNoWe require all animals currently residing in your household to be up to date on vaccines. You may be asked to provide proof of vaccination records.If no, why not?List any medical issues of your current petsWe mandate purchase of pet insurance, once approved. Do you agree to purchase it?Your veterinarian's name and phone #:Please describe briefly why you would like to adopt?Type of Animal preferred Dog Cat Please describe your level of animal handling experience with puppies & dogs:(Required)Please describe your level of animal handling experience with kittens & cats:How many hours during each work day will the animal be without direct care?0-1 Hours2-3 Hours4-5 Hours6-7 Hours8+ HoursWhere will the animal stay while you are at work or when you are not home?(Required) Where will the animal sleep at night? Do you have any objection to Pawsome Squad conducting an on-site visit to your home where the animal(s) will be kept?(Required) Yes No Do you accept the terms listed on this page? Yes No By hitting the submit button below, you agree to all the terms listed on this page.Please List 3 References with name and contact numbers-Family, Friend, and Employer(Required)
