Pets In Distress, Inc.

Pets In Distress, Inc.

Name: ______________________________ Home Phone Number: ___________________ Address: ____________________________ Work Phone Number: ___________________ City/State/Zip: ________________________ Driver''s License Number: _________________________ How did you hear about us? _____________________________________________________________________ How many companion animals have you had in the last 5 years? ___ Types of animals you have had: ___________________________________________________________________ Have you ever adopted a companion animal from a shelter/rescue group before?_____ Have you ever turned a companion animal in to a shelter/rescue organization before? ______ (If yes give reason and circumstances): ______________________________________________________________ 2) Do you ...
Rent Own
If you rent or lease, are your payments....
Yearly Monthly Weekly 7) Preferred age: ___ Preferred sex: ___

8) Preferred Breed: ___________

9) Long/Short Hair: ________ Color: _______

3) How many people reside in household?
Adults: ___ Children: ___ Ages: __________________ 10) Is anyone in household allergic to animals?
Yes No 4) Do you have any animals now? ___________________
List the animal(s) type, breed, age, the animal(s) temperament and any special needs or medical problems below:
____________________________________________
____________________________________________
____________________________________________
____________________________________________ 11) Will the companion animal be living...
Indoors Outdoors Both

12) What type of fencing does the yard have?
Chain Wood Cement
How many feet high: _________

13)Do you have a pool? _______ Above Below
_________________________________________________

5) Veterinarian''s Name, Address, and Phone Number:
____________________________________________
____________________________________________
____________________________________________ If at any point in time I find I cannot keep or am unable to
keep a Pets In Distress Inc. pet, the pet will be returned to
Pets In Distress Inc.

Signature: _______________________________
Date: _______________

DOG ADOPTION FEE INCLUDES:
Sterilization, Dewormings, Shots, Rabies, and Heartworm Test
DOES NOT INCLUDE:
Bordetella, Corona, or Lyme Shots
PUPPY ADOPTION FEE INCLUDES:
Sterilization, Dewormings, Shots, Rabies, and Heartworm Test
DOES NOT INCLUDE:
Bordetella, Corona, or Lyme Shots
CAT/ KITTEN ADOPTION FEE INCLUDES:
Sterilization, Dewormings, 2 F.D.R.C. Shots
DOES NOT INCLUDE:
Leukemia Test, Leukemia Shots, or Rabies