Pet Guardians
Adoption Application

Name:  __________________________    I want to adopt: Dog _______   Cat ________
Address: ________________________________________________________________  
Phone: (____)_____________   E-mail Address: 

Partner/Spouse/Roommate/family members: ________________

Are there children in the home?   Yes ____   No  ____

	(1)  How many children?        Age (s)?  

How long have you been at your present address?       years

Place of Employment:                               

Why do you want to adopt a dog/cat? 

Who will be responsible to care for the pet? 

Have you applied to any other rescues?  Yes  ____   No  ___

If yes, list them: 

	(1)
	(2)
	(3)

Have you ever had a pet before? 		 Yes _____  No ______
Have you ever taken a pet to a shelter?           Yes _____  No ______
Have any pets passed away in your care?        Yes _____  No ______

If yes, please explain:

List pet(s) that you currently have:

Name		       	 Species/breed	            Age         Sex	     Neutered/Spayed

(1) ___________________    ______________      _____     F __ M__   Yes __   No __
(2) ___________________    ______________      _____     F __ M__   Yes __   No __
(3) ___________________    ______________      _____     F __ M__   Yes __   No __
(4) ___________________    ______________      _____     F __ M__   Yes __   No __
If necessary, please include other pets on back of sheet.

Who will be the vet for this dog/cat?                   Phone number of office:       

Have you used this vet in the past?     Yes ____   No ____

In what type of housing do you live?   own home ____  rent ____  neither ____

If  you rent, are pets allowed? _______________  Landlord’s name _________________
						         Phone Number:  _________________

Would you agree to having a home visit by the Pet Guardians?  Yes ____   No ____

If no, please explain: 

If you travel out of town, what plans would you make for the pet?

If you cannot keep the pet for any reason, what would you do with him or her?

How many hours per day will the pet be alone?  _______ hours per day

Where will the pet be kept during the day and night?  

Cats Only:

	Will this pet be allowed outdoors?  Yes  ____   No ____

Dogs Only:

Is your yard fenced?  Yes ____  No _____  
Describe fence:
How do you plan to provide the dog exercise? 

I have given much thought to this adoption, and the information I have provided is
accurate. I understand that providing false information will automatically stop the 
adoption process.

Signature: ___________________________   date: ___________

Please send via email to ThePetGuardians@yahoo.com  or to Pet Guardians, P.O. Box 155, Willow Street, PA 17584.