Friends with Four Paws Adoption Application

Name of pet you are interested in adopting:*

If you are not applying for anyone specific, what are you looking for in a dog?

Are you looking for a companion for a current pet?*

YesNo

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How long have you lived at your current address?*

Do you currently:*

If you rent - Name of complex & landlord/manager's phone number:

If you rent, are pets allowed in your building?

YesNo

Home Phone:

Cell Phone:*

Email Address:*

Alternate contact name (Parent, sibling, etc.) & phone number:

Number of adults in your household and ages:*

Number of children & ages:

Occupation & Employer:*

If you are not employed, please explain how you will pay for the care of your new pet:

Are you currently a student?

YesNo

If you answered yes to the previous question, are you full or part time? Please include the name of your school.

Please list spouse or roommates names and phone numbers.

Who is this pet for?*

YourselfSpouseChildSomeone else

The new pet will stay indoors what % of the time?*

The new pet will stay outside what % of the time?*

Please clarify:*

Do you anticipate the new pet being left alone for extended periods of time each day?*

YesNo

Where will it be kept while alone?*

Do you have a fenced yard?*

YesNo

Type of fencing:

Name of veterinarian, clinic name and phone number:*

*Part of our reference process is to call your current vet to get information on vaccines and treatment. Because of this, we need the name of any past or present pets and the name the account is under. You may also have to call your vet to give them permission to speak with us. We do this check to make sure any existing pets are vaccinated, spayed/neutered, and has a positive history of diagnostic and preventative care. You can also e-mail your pet's vaccination records to: elyse@friendswithfourpaws.org

Have you E-mailed your current and previous vet records?

YesNo (please call my vet)I will ASAP

Are all of your pets current on vaccinations?

YesNo

Have you turned in any pets to the shelter in the past 5 years?*

YesNo

How many?

Why?

Have you had any pets pass away in the past 5 years?*

YesNo

How many?

Why or how?

If you do not have any pets, have you ever cared for one in the past?*

YesNo

Please explain:

Please list all the dogs, cats or other pets currently cared for in your household. Include age, male/female, whether spayed/neutered and if on heartworm preventative medication.*

References (List 3 personal or professional references. Only 1 family member may be listed.)

Reference #1

Reference Name:*

Relationship:

Email Address:*

Phone Number:*

Reference #2

Reference Name:*

Relationship:

Email Address:*

Phone Number:*

Reference #3

Reference Name:*

Relationship:

Email Address:*

Phone Number:*

General Questions

Have you considered what you would do with your pet if you need to move? Please explain.

Your pet may live 15+ years. What would you do with your pet if you could no longer care for it?

Is anyone in your home allergic to pets?

YesNo

Do you feel financially secure to provide your pet with basic medical care and necessary medical care in case of an emergency?*

Are you aware heartworm disease is common in dogs?

YesNo

I have concerns/would like more information on the following regarding this pet:

How will you keep your dog confined to your property? (Check all that apply)*

I believe this pet will cost about (Select one) per month to keep.

I have the ability to pay for veterinary fees of emergency care for this animal of:

If I cannot afford the pet's veterinary care, I will:

Additional questions or information requested:

How did you hear about Friends With Four Paws?*

I verify the above information is true and correct. I understand that if any information provided by me is false or inaccurate, I will not be eligible to adopt from this organization now, or at any time in the future.

Your Name:*