Application

Applicant Name(required)

Name of Pet You Wish To Adopt(required)

Age of Applicant :(required)

Email(required)

Phone(required)

Employed By(required)

Address(required)

City(required)

State(required)

Zip Code(required)

How long have you lived at this address?(required)

Do you own any pets? (Please list name, breed, age, and if they are spayed/neutered))(required)

List any pets you have had in the past 5 years, but no longer have. (name, age, gender, and why you no longer have them)(required)

Veterinarian's name(required)

Veterinarian's phone number(required)

NOTE: Due to Federal Laws regarding the privacy act, you will need to contact your vet and give permission for PVHS to contact them regarding the status of your pets.

Do you own or rent your home?(required)

Own Rent

If you rent please provide landlord's name and phone number(required)

Where do you currently live?(required)

House Condo Apartment Mobile Home

Type of area(required)

City Suburb Rural

Do you have a fenced in yard?(required)

Yes No

Is it attached to the house?(required)

Yes No

What type of fencing?(required)

If you don't have a fence how will the dog be allowed to exercise/eliminate waste?(required)

Number of adults in the household(required)

Number of children in the household and age(s) (required)

Who will be the primary caretaker of the pet?(required)

How many hours in the day will the pet be alone?(required)

Where exactly will the pet stay during the day/night?(required)

Who will take care of the pet in the event of an emergency or vacation?(required)

If you adopt a puppy or kitten, do you agree to have it spayed/neutered at your own expense in a few months?(required)

Yes No

Terms and Conditions(required)

I will never use the animal for research or fighting I will not use the animal for breeding purposes I will provide regular veterinary care I will provide proper food water shelter and companionship I will not subject the animal to abuse or cruelty I will agree to spay or neuter the animal if not already done I will NOT tie the dog to a leash rope or chain as a means of confining the animal except for emergency or for a short period If for any reason I am unable to keep the animal I will NEVER sell or give away pet–I will return to PVHS

Date of Application(required)

Best time to contact you(required)

Signature of Applicant(required)

Please make sure to email us 4-5 pictures of your yard ONLY to poteaupets95@gmail.com.

Also make sure to call your vet office to allow us to obtain a vet record. If you do give annual shots at home we must have veterinarian proof of current pets rabies vaccination.

If we do not obtain photos and a vet reference your application MAY be denied. Thank You for choosing adoption!

Share this:

Like this: