Date Date Format: MM slash DD slash YYYY Personal InformationName* First Name Last Name Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone 1*Phone 2Date of Birth* Date Format: MM slash DD slash YYYY DL Number*DL State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State EmployerEmployer's AddressMarital StatusSingleMarriedSeparatedDivorcedWidow(ed)Housing StatusRentOwnLive with relativesChildren in the HomeNoYesChildren's AgesPet OwnershipHave you ever owned a pet?NoYesIf yes, please list any pets you have owned that are not currently living with you:Pet 1BreedHow longOutcomePet 2BreedHow longOutcomePet 3BreedHow longOutcomeDo you currently have any pets?NoYesHow many?Please list any pets currently living with you.Pet 1NameBreedAgeGenderMaleFemaleSpayed/NeuteredYesNoCurrent on VaccinationsYesNoPet 2NameBreedAgeGenderMaleFemaleSpayed/NeuteredYesNoCurrent on VaccinationsYesNoPet 3NameBreedAgeGenderMaleFemaleSpayed/NeuteredYesNoCurrent on VaccinationsYesNoHave you ever surrendered a pet to an animal shelter or rescue organization?NoYesIf yes, please explain the situation.Is anyone in the home allergic to pets or pet hair?NoYesIf yes, how will you cope with the situation?Fostering PlansWhat kind of pet are you interested in fostering?Will this be an indoor or outdoor pet?IndoorOutdoorHow many hours a day will you be able to spend with this pet?Where will the pet stay when you are at work or away from home?Where will the pet sleep at night?MiscellaneousIs your property fenced?NoYesIf yes, please give fence type and height.What will you do with your pet when you travel?If your pet becomes ill, what will you do?How do you plan to exercise the pet?What happens to the pet if you discover a bad habit we have not identified (i.e. chewing, digging, etc.)?Personal ReferencesReference 1 NameReference 1 PhoneReference 1 Email Reference 2 NameReference 2 PhoneReference 2 Email Reference 3 NameReference 3 PhoneReference 3 Email Landlord's InformationLandlord NameLandlord PhoneLandlord Email Veterinarian's InformationVet NameVet PhoneVet Email AgreementI HEREBY CERTIFY THAT ALL INFORMATION PROVIDED HEREIN IS TRUE AND THAT I HAVE ANSWERED ALL QUESTIONS HONESTLY. I FURTHER CERTIFY THAT I AM AT LEAST 21 YEARS OF AGE. I UNDERSTAND THAT PROVIDING FALSE INFORMATION WILL RESULT IN THE APPLICATION BEING DENIED. I UNDERSTAND THAT PAWS RESERVES THE RIGHT TO DENY ANY APPLICATION FOR ANY REASON FOR THE SAKE OF PROTECTING THE WELFARE OF THE ANIMAL. I UNDERSTAND THAT THIS APPLICATION IS SUBJECT TO THE APPROVAL OF THE PAWS RESCUE AND ADOPTION COMMITTEE. I FURTHER UNDERSTAND THAT I WILL BE NOTIFIED OF AN APPROVAL OR DENIAL WITHIN 7 DAYS OF THE COMPLETION OF THIS APPLICATION. IF MY APPLICATION IS DENIED I UNDERSTAND THAT PAWS MAY OR MAY NOT DISCLOSE THE REASON(S) THE APPLICATION WAS DENIED. I UNDERSTAND THAT I HAVE ONLY SUBMITTED AN APPLICATION TO FOSTER AND THIS IS NOT A CONTRACT AND THAT APPROVAL IS NOT GUARANTEED. I HEREBY AUTHORIZE PAWS TO CONTACT MY REFERENCES AS PART OF THE SCREENING PROCESS FOR FOSTERING.* I acknowledge that I have read and fully understood the terms and conditions of the foregoing Adoption Agreement and Contract and that I will comply with the same. PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
