PKR Dog Adoption Questionnaire

This is a questionnaire for interest in adopting a Pawsitive Karma Pet. Please fill out this application truthfully and exact. A representative will be contacting you shortly. Thank you for your interest in adopting a rescue pet!

Adoption Policies: Individuals must meet the following criteria in order to adopt an animal from PKR.

- At least 18 years of age
- Provide government issued identification showing your name and current address - If you are renting, you must have the consent of your landlord to keep the animal, and have paid your pet deposit prior to adoption
- Under no circumstances are you to surrender the animal to a shelter or any other location besides PKR, without the express permission of PKR
- You must take the animal to a qualified veterinarian within 25 days of adoption, and obtain all necessary vaccinations on schedule
- Register the animal's microchip with your owner information within 24 hours of adoption
- Agree to send follow-up reports on animal well-being when requested by PKR within 24 hours of request
- Agree to a high quality diet for your new pet that has been approved by PKR

Adopter Info

First Name *

Last Name *

Street Address *

City and State *

Zip Code *

Date of Birth *

Email Address *

Primary Phone Number *

Alternate Phone Number *

What is your current occupation? *

Do you rent or own? *

If you rent, do you have permission for this pet? *

What is your Landlord's Name? *

Landlord's Best Contact Number *

Please check the best description of your outdoor space. *

No Yard

Mini Yard (apartment/town home)

Full Standard ddYard

.25 acres or more

Do you have a spouse? *

Yes

No

Spouse First and Last Name *

What part will he/she have in caring for this pet? * 🛈

Do you have children? *

Yes

No

How many, and what ages? * 🛈

What are their experience with animals? How do they handle animals and interact? *

Current and Past Pets

Do you currently own pets? *

Yes

No

Please list current pets. Include age, gender, and breed. (Past 10 years) *

Please list any pets who are not fixed or vaccinated. *

Current Vet's Clinic Name *

Animal Clinic's Number *

Please list past pets and where they currently are. If passed away, how? (past 10 years) *

Have you ever given up a pet? *

If you have given up a pet, please explain why. *

Have you ever declawed a pet before? *

If yes, please explain why. *

New Pet

If you have a specific pet(s) in mind, what pet are you interested in?
*

What are you looking for in a pet? *Please list energy level, behavior, etc. *

Where will your pet primarily be kept? *

How many hours will your dog be left outdoors. *

Please explain when your new dog will be outdoors. *

Where will your pet be kept when you are away from home? *

Where will your pet sleep? *

What are unacceptable behaviors of your new pet? *

How will you resolve this behavior? *

How do you plan to introduce your new pet to your current pets? (If you have pets)

On average, how many hours will you be away from your pet? *

What amount would you spend on emergency care for your pet? *

What will happen to your pet if you cannot keep it? *

What will happen to your pet if you move to a different city within the state? *

What will happen to your pet if you move out of state? *

If single, what will happen to your pet if your spouse is allergic? *

Do you plan to alter your new pet's appearance in any way?

Such as, ear clipping, tail clipping *

If yes, why and how?

We recommend purchasing items (if you do not already have them) to entertian your pet while you are away and supplies to ensure that they have a happy and health life.

Please check items you are willing to provide. *

What brand of food do you plan to feed your new pet?

Please specify brand and type. *

Please list any other remarks or concerns we should consider. *

How did you hear about Pawsitve Karma Rescue? *

If other, please explain. If referred by someone, what is their first and last name? *

By signing below you are agreeing that all the information in this questionnaire is completely accurate to the best of your knowledge. Please type your name below and date, this will act as your signature.

E Signature of Adopter *

Today's Date * +

Thank you for considering a rescue pet!