PHS Adoption Application
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pet's Name
*
Pet's PHS Number
Why do you want to adopt this pet at this time?
*
Is it okay to have this pet where you live?
*
Yes
No
Do you have the resources to care for this pet, including food, heartworm prevention and health care?
*
Yes
No
Do you have a fenced yard?
*
Yes
No
Other
If you do not have a fenced yard, what are your plans to keep a pet safely confined? (If you answered yes to the previous question, respond N/A.)
*
Number and ages of children in your home.
Number and ages of pets in your home.
Name and phone number of your vet.
*
Where will this pet be kept when you are not home?
*
How long will this pet be left alone each day? Explain.
*
Where will this pet be when you are home?
*
Where will this pet sleep?
*
Have you ever rehomed a pet or surrendered your pet to a shelter? Please explain.
*
Submit
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