Adoption Application

Date *
Date
Family and Living Information
Your name *
Your name
Date of birth *
Date of birth
Address *
Address
Phone *
Phone
If yes, please provide details.
If yes, please provide details.
If so, what kinds?
Adoption & Care Information
For example, will they have run of the house, outside only, confined to one room, sleep in crate.
If yes, please list them and include (species, breed, age, sex, name).
Do you know that in the first year, regular preventative care may cost $150+ for a cat/dog? *
Did you know that in the first year, pet food and pet supplies may cost $100+? *
It may take three weeks or more for this new pet to adjust to your home (depending on the household). Are you willing to give ample time for adjustment? *
We will contact your vet to confirm your pets are current on shots and have been in good care.
References
Please provide three NON-FAMILY references. Indicate their relationship to you. References should be able to attest to your interest in adoption, your love for animals, your ability to care for a pet, and your general level of responsibility.
Reference 1
Name *
Name
Phone *
Phone
Reference 2
Name *
Name
Phone *
Phone
Reference 3
Name *
Name
Phone *
Phone
I declare that the information I have provided in this application is true and correct. I understand that if any information herein is found to be false that my application can be refused and/or (2) if the pet has already been adopted, said pet shall be relinquished to Poweshiek Animal League Shelter (PALS) without refund of the adoption donation. 1 agree that although all pets are medically examined and treated before placement, evaluated for personality and every effort is made to match an appropriate pet with each home, no guarantees are expressed or implied as to personality or medical soundness of the pet by PALS. I agree to accept the animal "as is" and understand that the adoption donation is non-refundable. I understand that home checks can be made on a random basis prior to and following adoption. 1 specifically give PALS, or their designee, permission to conduct a home check, as they deem necessary at a time of mutual agreement. I understand and agree that any material and substantial breach of this agreement shall entitle PALS to take possession of the animal with or without notice. If, in the opinion of PALS or their designee, conditions warrant removal of the animal from the home, PALS retains the right to remove the animal from the premises without a refund of any monies paid. This agreement shall be binding upon any party in whose possession the pet may be found.
PALS serves people and pets from across the state of Iowa through its programs, which include pet adoption, humane education, community outreach, spay/neuter, animal cruelty intervention and much more. It costs roughly $15 to care for one pet per day. Would you consider becoming a PALS sustaining member and sponsor the life of a shelter animal, the truly helpless? *
Sustaining members are PALS supporters that are set up for automatic monthly donations.