Adopt A Pet – Crossed Paws Pet Rescue

Contact Information

If you have no preference to a specific question, please say so
Name:*
First Middle Last
Occupation (If none, please type "none"):*
Address:*
Street Address Address Line 2 City State ZIP Code
How long at this address?*
Daytime Phone:*
Evening Phone:
Best time to call:*
Email:*
Enter Email Confirm Email

How many adults are there in your family (their relationship to you)?*
Family & Housing
How many children (ages)?*
What type of home do you live in single family, town home, apartment, farm, etc.?*
Please describe your household:*
- Active
- Noisy
- Quiet
- Average
If you rent, please give the rules governing pets and the landlord’s name and number. If you do not rent, please state:*
(By providing this information you are allowing Crossed Paws Pet Rescue to contact your landlord please inform them of this call so they will speak with us.)
Does anyone in the family have an allergy to dogs?*
Is everyone in agreement with the decision to adopt a dog?*
Do you have time to provide adequate love and attention?*

Veterinarian
Do you have a regular veterinarian?
Veterinarian’s name:*
Clinic Name:*
Clinic Address:*
Street Address Address Line 2 City State ZIP Code
Clinic Phone:*
(Providing Crossed Paws Pet Rescue with this information you are allowing Crossed Paws Pet Rescue to call your vet. Please call your vet and ask them to authorize the release of information to Crossed Paws Pet Rescue.)

About the Dog You Wish to Adopt
What is your idea of an ideal dog and why?*
Desired Age:*
Desired Size:*
Desired Breed:*
Breed you would not adopt:*
Desired Sex:*
Willing to adopt:*
- outgoing/hyper dog
- dog that needs regular medication
- dog that needs grooming
- shy dog
- dog that needs training
- none of these
Where will the dog spend the day? (describe)*
Where will the dog spend the night? (describe)*
Number of hours (average) dog will spend alone:*
Who will have primary responsibility for this dog's daily care?*
Who will have financial responsibility for this dog?*
Do you agree to provide regular health care by a Licensed Veterinarian?*
Do you agree to keep the dog as an indoor dog?*
When the dog goes out, how do you plan to supervise it? Fenced yard?*
Do you agree to contact CPPR if you can no longer keep this dog?*
Do you agree to keep CPPR as an emergency contact on your microchip?*
Are you be willing to let a representative of CPPR visit your home by appointment?*

General Questions
How did you hear about CPPR?*
Would you be interested in fostering?*
Do you agree to pay a small adoption fee that covers their first set of shots, spay/neutering, micro chipping and deworming?*

Personal References

Please list someone who is familiar with both you and your pets.
Reference 1 Name:*
First Last
Reference 1 Address:*
Street Address Address Line 2 City State ZIP Code
Reference 1 Phone:*
Reference 1 relationship to you (relative, neighbor, friend, etc.):*
Reference 2 Name:*
First Last
Reference 2 Address:*
Street Address Address Line 2 City State ZIP Code
Reference 2 Phone:*
Reference 2 relationship to you (relative, neighbor, friend, etc.):*

Please Sign Below

All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.
Signature*

Contact Information