Pals-Pets | Pets-A-Lone Sanctuary

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Pet Information
Pet's Name*
Pet Type*
Information About You
First Name*
Middle Initial*
Last Name*
Your Age (applicant)*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Work Phone*
Cell Phone*
Alternate Phone
Email*

Email is Pals-Pets Preferred method of communication. If you do not have an Email account please call us at 636-338-1818
Employment (Check One)*
- Employed
- Self-Employed
- Retired
Place of Employment
Home Ownership/Rental Information (Check one)*
Landlord Name
Landlord Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Phone
Municipal/Landlord Rules
Breed Restrictions*
- Yes
- No
If Yes Explain
Size or Weight Restrictions*
If Yes Explain

References (Please Provide Two References That We May Contact)
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
Email*
Relationship to Applicant*
Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Cell Phone*
Email*
Relationship to Applicant*

Please Answer the Following Questions
Are all members of your household in agreement with this adoption?*
If No Explain
Number of Adults in your household*
Please provide the names and ages of each person living in your household (click the + sign to add additional names)*
Name Age
Who will be the primary care taker of your new pet*
List any other pets in your household*
Are your pets spayed/neutered?*
If No Please Explain why
Who is your veterinarian or who do you plan to use (Please list name and contact information)?*
Do you have a fenced in yard?*
Do you have a pet kennel?*
How many hours a day will your new pet be home alone?*
Where will your pet sleep at night?*
If adopting a cat, will you allow your cat to go outside?*
If yes how ill you provide for the safety of the cat?*
Have you adopted from an animal welfare group before?*
If yes, who did you use?
If you had to give up your pet, what would you do with it?*
How did you hear about PALS?*
Acknowledgement
This questionnaire is designed to help PALS and yourself determine if a specific animal is the right one for your household. Please read and check that you agree with the below statements.
*
- I agree
I understand that a pet can be an eighteen (18) year commitment and must be regularly exercised, groomed and can cost $ 500.00 (or more) a year to care for
*
- I agree
PALS reserves the right to deny any adoption, based on answers provided on the questionnaire, and/or from the interview prior to adoption

Pet Information

Name	Age