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FUR~Friends United in Rescue Adoption Application
Date
*
-
Month
-
Day
Year
Date
Name of Pet You Wish to Adopt
*
Sex
*
Male
Female
Name
*
First Name
Last Name
Email Address
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Cell Phone Number
*
-
Area Code
Phone Number
Home Phone Number
-
Area Code
Phone Number
Employer
*
Position
How long have you worked there?
*
Employer Phone Number
*
-
Area Code
Phone Number
Do you own or rent your home?
*
Own
Rent
If own, length of time at current residence
If rent, landlord's name
Landlord's Phone Number
-
Area Code
Phone Number
Are pets allowed?
Yes
No
Not 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?
Yes
No
Are any members of your household allergic to dogs?
Yes
No
Do you own any pets?
*
Prior Pet History
List the animals by name that have been part of your family during the last 5 years. Indicate the status of each using the drop down menu codes.
1. Pet's Name
Species
Cat
Dog
Other
1. Pet Breed
Status
Still with me
Deceased
Gave Away
Lost/Ran Away
Sold
Gave to Shelter
Euthanized
Unknown
2. Pet's Name
Species
Cat
Dog
Other
2. Pet Breed
Status
Still with me
Deceased
Gave Away
Lost/Ran Away
Sold
Gave to Shelter
Euthanized
Unknown
3. Pet's Name
Species
Cat
Dog
Other
3. Pet Breed
Status
Still with me
Deceased
Gave Away
Lost/Ran Away
Sold
Gave to Shelter
Euthanized
Other
4. Pet's Name
Species
Cat
Dog
Other
4. Pet Breed
Status
Still with me
Deceased
Gave Away
Lost/Ran Away
Sold
Gave to Shelter
Euthanized
Unknown
Are your current pets up-to-date on vaccines?
*
Yes
No
N/A
Are your current pets spayed or neutered?
*
Yes
No
N/A
Are your current pets on heartworm preventative?
*
Yes
No
N/A
Veterinarian's Name or Practice
*
Veterinarian's Phone Number
*
-
Area Code
Phone Number
Where will this pet spend most of its time?
*
Crate
Indoors
Outdoors
Garage
Basement
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
*
-
Month
-
Day
Year
Date
Submit
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