First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone x
Cell Phone
Alt Email
Which animal are you interested in Choose an animal: Abby Cooper Fritz Guinness Haley Jackson Leo Lexi Ozzie & Oreo Paolo Parker Tito
Name of dog(s) of interest if not found above
How did you hear about us*
Employment type and schedule (work, retired or otherwise home & normal work schedule)*
Would you allow a P.H.A.R. representative to do a home check? Home checks simply ensure the safety of the environment for the animal, not to check housekeeping.*
In what type of home do you live* Choose one: House Apartment Condominium Mobile Home Townhome
Do you own or rent your home?* Choose one: Own Rent Live with parents
If you rent does the property allow pets? We will need a copy of landlords approval for addition of pets.*
Do you have a fenced-in yard?* Choose one: Yard Completely Fenced Yard Partially Fenced Unfenced Yard No Yard
What type of fence and how high is it?* Choose one: Block Wall Block Wall & View View Fencing Chain Link Other *explain in comments
What type of yard* Choose one: Patio area only Pavers or cement Mostly gravel Desert landscape Area(s) of real grass Area(s) of artificial turf Other *explain in comments
Do you have a doggy door Choose all that apply: No, we do not have a doggy door. Other Yes, and we do not use it/it is closed off. Yes, and we use it. Yes, but there is a safety outdoor enclosure around it.
Do you have a swimming pool* Choose one: No pool Fenced pool Unfenced pool
Number of adults in your home* Choose one: 0-None 1 2 3 4 5 6+
How many children live in your home and what are their ages*
How many children potentially visit the home and what are their ages*
Describe other pets in home - name, breed, sex, age, spayed/neutered*
Have you previously owned any pets, if so, what kind of pet and when?*
Veterinarian's Name and Phone Number*
What is the greatest number of hours the pet will spend alone daily/nightly*
How much time will the animal spend alone during the day*
Where will the dog's main sleeping quarters be*
Will someone be home with your pet during the day?* Choose one: No Other Yes
Where will your pet spend most of their time?
Additional Comments
Have you ever given up a pet? If yes, please explain*
Do you plan to care and provide for the pet for a lifetime despite changes in your life such as moving, having a baby/grandchildren, or getting a divorce?*
Tell us what your newly adopted pet's life will look like if you are selected to adopt them.*
Post Adoption Agreement: by checking the following boxes and signing this application you agree to the following items. Adopting a dog, you will abide by your town's leash law. You would return the animal to PHAR if you feel for any reason you cannot keep him/her. You must not sell or otherwise rehome the animal without notifying PHAR. You will inform neighbors and family members not living with you that PHAR must be contacted in the event you are no longer able to care for this dog(s). You are responsible for providing proper shelter, food, water, exercise, medical care and humane treatment at all times for your dog(s). You are willing and financially prepared for long-term medical and dental care for the dog(s).* Choose one: Yes No
I certify that the information given on this application is true and correct. If I am approved by P.H.A.R. to adopt an animal, I agree to all the above requirements. I understand that failure to comply with any of the requirements will result in confiscation of the adopted animal. If you are selected to adopt a pet you will be required to physically sign this form before the adoption can be finalized.* Choose one: I agree.
I certify that the information entered on this applicant is true. Enter your name and date*