Adoption Form

FUR~Friends United in Rescue Adoption Application

Date*

Date

Name of Pet You Wish to Adopt*

Sex*

MaleFemale

Name*

First NameLast Name

Email Address*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Phone Number*

Area CodePhone Number

Home Phone Number

Area CodePhone Number

Employer*

Position

How long have you worked there?*

Employer Phone Number *

Area CodePhone Number

Do you own or rent your home?*

OwnRent

If own, length of time at current residence

If rent, landlord's name

Landlord's Phone Number

Area CodePhone Number

Are pets allowed?

YesNoNot sure

Number of adults in the household?*

Number of children in the household?*

Ages of children

Roommate/Spouse's Name*

Are any members of your household allergic to cats?

YesNo

Are any members of your household allergic to dogs?

YesNo

Do you own any pets?*

1. Pet's Name

Species

CatDogOther

1. Pet Breed

Status

2. Pet's Name

Species

CatDogOther

2. Pet Breed

Status

3. Pet's Name

Species

CatDogOther

3. Pet Breed

Status

4. Pet's Name

Species

CatDogOther

4. Pet Breed

Status

Are your current pets up-to-date on vaccines?*

YesNoN/A

Are your current pets spayed or neutered?*

YesNoN/A

Are your current pets on heartworm preventative?*

YesNoN/A

Veterinarian's Name or Practice*

Veterinarian's Phone Number*

Area CodePhone Number

Where will this pet spend most of its time?*

Where will the pet stay when you are away on vacation?*

What is the soonest date that you would like to meet and greet?*

By clicking the submit button, I agree to the FUR~Friends United in Rescue adoption process, may undergo a home check, and interview at the discretion of FUR~Friends United in Rescue.
By clicking the submit button,i agree to let FUR~Friends United in Rescue to contact my veterinarian(s) to check the care provided to previously and/or current pets and to check the spay/neuter history.
By clicking the submit button, I authorize FUR~Friends United in Rescue to contact my landlord to ensure that I have his/her permission to keep pet(s) on the premises.
By clicking the submit button, I authorize FUR~Friends United in Rescue to contact my employer to confirm employment.
By clicking the submit button, I certify that the statements made on this application are true and accurate to the best of my knowledge. I understand that false statements by me may lead to the rejection of this application for adoption.
I give my permission for FUR~Friends United in Rescue to use photos and/or media of myself and/or adopted dog freely. This includes publishing on FUR's Facebook Rescue page, FUR website, or future video productions. I also allow any pupdates I share with FUR to be shared freely.
Release: The ADOPTER agrees to accept responsibility of the Dog at the ADOPTER's own risk. The adopter, and the adopter's spouse, heirs, executors, personal representatives and assignees, agrees never to bring a claim or suit against Friends United in Rescue. The adopter releases Friends United in Rescue and its directors, founders, employees, officers, agents, representatives, contractors, volunteers, successors and assigns from all liability arising from meeting or adopting the Dog. The adopter understands that this agreement discharges Friends United in Rescue and its directors, founders, employees, officers, agents, representatives, contractors, volunteers, successors and assigns from any liability to the adopter and the foster's spouse, heirs executors, and assignees, with respect to bodily injury, personal injury, illness, amputation, scarring, death, property damage or other loss that may result from the fostering or behavior or activities of the Dog. The adopter releases Friends United in Rescue and discharges Friends United in Rescue and its directors, founders, employees, officers, agents, representatives, contractors, volunteers, successors and assigns from any liability for Friends United in Rescue's own negligence or liability that may result in bodily injury, personal injury, illness, amputation, scarring, death, property damage or other loss to the adopter..

Signature

Date*

Date

Prior Pet History