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** PLEASE NOTE: ALL FIELDS ARE REQUIRED **
 Which animal are you interested in adopting? 
Contact Information
 Name:
Referred By:

If other, please specify:

 Address:
 
 Phone(s):
 Email:
 Is the pet for:   You   Your Family   Another Person
 Are you over 21 years of age?  Yes   No 
Residence
Own   Years
   House
   Condo
   Trailer Home
Rent   Years
 OK with landlord?  Yes   No 
 Landlord's Name: 
 Landlord's Phone: 
 Does your residence have a "doggie door"? Yes   No 
 Your Employer:   Name:   Phone: 
 Describe the nature of your work:  Years: 
 Spouse's or Partner's Employer:  Name:   Phone: 
 Describe the nature of their work:  Years: 
 Spouse's or Partner's attitudes about adopting a pet:
 Children:  Number:  Ages:
 Please list all persons living in the home who are not your spouse/partner or child as listed above:
 Nearest Relative:   Name:   Phone(s): 
 Personal Reference:   Name:   Phone(s): 
 ALLERGIES:  Do you or any members of your household have allergies to cats or dogs?
 Yes   No 

 Why are you interested in adopting a pet?
 Who will be responsible for the daily care of the pet?
CAT:  How often will you let the cat go outside? 
   What are your views about declawing? 
DOG:  Is your yard fenced? What is it made of? What outdoor protection do you have prepared for a dog? 
   When would the dog be allowed indoors - how often, and in what parts of the home? 
 Is a home visit, arranged with a CAWS volunteer, OK?   Yes    No  
 Please provide history of prior pets, including: type, how long you had them, why they are no longer with you:
 Please provide following information about current pets you have:
 Type: 

 Age: 

 Spayed/Neutered:
 Yes    No  

 Where you got the pet from:
 

 How long have you had this pet?
 

 Shots: 

 Dental Care:   Yes    No  

 Declawed (cat)?
 Yes    No  

 Type/Brand of food:
 

 Does pet have license?
 Yes    No  

 Is pet Microchipped?
 Yes    No  
 Type: 

 Age: 

 Spayed/Neutered:
 Yes    No  

 Where you got the pet from:
 

 How long have you had this pet?
 

 Shots: 

 Dental Care:   Yes    No  

 Declawed (cat)?
 Yes    No  

 Type/Brand of food:
 

 Does pet have license?
 Yes    No  

 Is pet Microchipped?
 Yes    No  
 Type: 
 Age: 

 Spayed/Neutered:
 Yes    No  

 Where you got the pet from:
 

 How long have you had this pet?
 

 Shots: 

 Dental Care:   Yes    No  

 Declawed (cat)?
 Yes    No  

 Type/Brand of food:
 

 Does pet have license?
 Yes    No  

 Is pet Microchipped?
 Yes    No  
 Who is your veterinarian?

Please Note: CAWS (Community Animal Welfare Society) reserves the right to refuse an adoption for any reason.

 Would you like us to send you a copy of the email we receive?   Yes    No  


CAWS - Community Animal Welfare Society
P.O. BOX 160554 • CLEARFIELD, UT 84016 • 801.328.4731 • www.CAWS.orgcawsdotorg@aol.comPrivacy

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