PATs Adoption Application Form

Date

Name of Pet You Wish to Adopt*

Name*

First NameLast Name

Date of Birth:*

Current Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

1. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

2. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

3. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email Address*

Employment*

Company Name and Number

If unemployed, how will you provide vet care and general expenses for your new pet*

How many people live in your home? Please list names and ages?

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

If you rent, please provide your landlord's information here:*

What is your landlord's pet policy?*

Do you currently have any pets?*

If yes to the above what is the name, age, and breed of your pet?

Are your pets spayed/neutered?

Please provide your veterinarian's name and phone number:

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

How many hours per day would the pet be alone?*

If you have to leave town, emergent or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Will you crate your pet?*

Please provide the names, emails, and contact numbers for 3 personal references:*

Have you ever been convicted of an animal related crime or violent crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

IC 15-20-4 states that all companion animals must be spayed/neutered. If you are adopting a puppy or kitten under the age of 6 months or the animal has a condition that does not allow it to be spayed/neutered you understand you will be responsible for getting the animal spayed/neutered. In accordance with IC 15-20-4 deposit of $75.00 will be made to PATs Animal Sanctuary in which you have 120 days to safely spay/neuter your animal. After the animal is spayed or neutered you must show proof of the procedure and the $75.00 will be returned to you. If you fail to complete the spay/neuter and show proof the deposit will be forfeited and under subsection (a)(2) the funds will be remitted to the BMV.

I have read and understand the above section. *

Type Name

By clicking the submit button, I agree to PATs Animal Sanctuary adoption process, will undergo a homecheck, and interview at the discretion of PATs Animal Sanctuary.
By clicking the submit button, I understand PATs Animal Sanctuary will check my references including veterinary and personal.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from PATs Animal Sanctuary and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, I understand that adoption donation is non-refundable.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify PATs Animal Sanctuary BY EMAIL OR PHONE and provide a 14 day period to allow PATs Animal Sanctuary to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless PATs Animal Sanctuary against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that PATs Animal Sanctuary will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to PATs Animal Sanctuary and provide transport to where PATs Animal Sanctuary deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*

Adoption Application

3 previous addresses: