Adoption Application (Word Document)
Potomac Valley Pet Rescue
P.O. Box 914
Petersburg, WV 26847
304-257-5435
Adoption Application
First Name: _____________________________ Last Name: ___________________________________
Address: ___________________________________________________________________________________
City: __________________________________ State: ________ Zip: __________________________
Phone 1: ____________________ Phone 2: ______________________ Email: ________________________
Type of pet you wish to adopt: _____________________ Pet Name if applicable: ________________________
Veterinarian: _________________________________________ Vet Phone: __________________________
Number of Children in household: _________ Ages: ______________________
Other Pets: __________________________ What type: ______________________________________
Have you had pets in the past? ________________ How many years did you own your pet? _______________
Reason for no longer owning your pet :___________________________________________________________
Do you rent your home?______________
(If renting you must have written permission for a pet from your landlord)Landlord Name / Phone:________________________________________________ _______________________
Type of living conditions for the animal (indoor, enclosure, fence, etc.): __________________________________
Arrangements for pet while at work? _________________________ How many hours away: _________________
What arrangements will be made for pet while on vacation? _____________________________________________