PHS Adoption Application

PHS Adoption Application
Date *

Month Day 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
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. *
Should be Empty: