Adoption Application PPI Adoption Application Please enable JavaScript in your browser to complete this form.Your Name *FirstLastYour Physical Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number (Daytime) *Phone Number (Evenings) *Email *EmailConfirm EmailHow did you hear about PPI Pet Rescue? *Personal Reference Name *FirstLastPersonal Reference Email *Personal Reference Phone *Personal Reference Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWhat is the name of the pet you wish to adopt? *What breed type or mix do you want to adopt? *Do you prefer male, female, or will take either? *MaleFemaleEitherWhat age range do you prefer? *Under 1 year oldBetween 1 and 5 years oldOver 5 years oldAge doesn't matterDo you prefer a particular color? (Yes or no, then describe if yes) *Do you have a fenced yard (Yes/No)? If you do, what type of construction is it? How tall is it? *Do you prefer short, medium, or long-haired? *Short-hairedMedium-hairedlong-hairedDoesn't matterHow big a pet do you prefer? *SmallMediumLargeExtra-largePlease explain why you want a dog or cat? *How active a pet do you want? *couch potatoenjoys walkslive wire!You may choose more than one activity level.What activities would you do with your pet? *Would your pet get physical exercise every day? *YesNoWhere will your pet be when you are home? *indoors, heated or cooled roomoutdoors, or no temperature controlindoors and outdoors, always with someoneWhen no-one is home, where will your pet be? *indoors, heated or cooled airoutdoors, or no temperature controlboth indoors and outdoors with someoneHow many hours will the pet be home alone (number)? *Where will the pet sleep? *Who will be primarily responsible for the pet? *Do all members of the family want this type of pet? Please explain yes or no and why. *Is anyone who will live with the pet allergic to pets? Please explain. *Have you ever relinquished a pet to an animal shelter or anyone else (Yes/No)? If so, please explain why and when. *Are you planning on obtaining obedience training? If so, would you like help in choosing a trainer? *What would you do if your pet developed behavior problems unacceptable to you? *What pet behaviors would be unacceptable to you and grounds for you to be unable to keep it? Why? *Do you currently have a veterinarian? May we contact them? *Your Veterinarian's Name and Street AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeYour Veterinarian's Phone NumberHow many adults are in your home? How old are they? *How many children are in your home? How old are they? *Are you prepared to share your life with a pet for 10-18 years, who is totally dependent on you for food, shelter, love, and veterinary care? Are you willing and able to make this life-long commitment to a pet as a family member? *YesNoAfter selecting Yes or No, please click the "Submit" button below to email your answers to the PPI Adoption Committee. Thank you!Submit
