FARRM Adoption Application
Date
*
-
Month
-
Day
Year
Date Picker Icon
Application for (Name of Animal(s)
*
Applicant Information
Name
*
First Name
Last Name
Age
*
Please Select
18-25 years old
26-34 years old
35-44 years old
45-59 years old
60 years old +
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Preferred method of contact
*
Please Select
Phone
E-mail
Are you
*
Please Select
Employed - Full-Time
Employed - Part-Time
Full-Time Student
Part-Time Student
Unemployed
On average, how long are you away from home on a daily basis?
*
Please Select
1 hour
2-5 hours
6-8 hours
8 hours +
Adoptive Home Information
Do you live in
*
Please Select
Apartment
Condo
Duplex
House
Other
Please describe your home type
*
Do you own or rent your home?
*
Please Select
Own
Rent
Please upload landlord approval for pets.
How long have you resided in your home?
*
How close is the nearest main road/highway to your home?
*
Do you have a fenced yard?
*
Yes
No
Please indicate fence height
Please describe your yard
If available, please include pictures of your yard
Adoptive Home Resident Information
Number of Adults (over 18 years old))
*
Please Select
1
2
3
4
5
6
Number of Children (under 18 years old)
*
Please Select
0
1
2
3
4
5
6
Are all residents in agreement regarding the adoption?
*
Yes
No
If no, please explain
Resident Pet Information
Have you had pets before?
*
Please Select
Yes
No
If they no longer live with you, please provide details
Do you currently have pets?
*
Please Select
Yes
No
Number of current resident pets
Please Select
0
1
2
3
4
Resident Pet #1 Information
Pet Type
Please Select
Dog
Cat
Small Animal (gerbil, hamster, rabbit)
Other
Age
Breed
Spayed/Neutered?
Yes
No
Resident Pet #2 Information
Pet Type
Please Select
Dog
Cat
Small Animal (gerbil, hamster, rabbit)
Other
Age
Breed
Spayed/Neutered?
Yes
No
Resident Pet #3 Information
Pet Type
Please Select
Dog
Cat
Small Animal (gerbil, hamster, rabbit)
Other
Age
Breed
Spayed/Neutered?
Yes
No
Resident Pet #4 Information
Pet Type
Please Select
Dog
Cat
Small Animal (gerbil, hamster, rabbit)
Other
Age
Breed
Spayed/Neutered?
Yes
No
Current Veterinary Clinic
Address
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
-
Area Code
Phone Number
Current Veterinarian Name
First Name
Last Name
Adoptive Home Preferences and Suitability
What Age of Animal are you Looking for?
*
Please Select
Young (0- 2 years old)
Young Adult (2-4 years old)
Adult (5-7 years old)
Senior (8 years +)
What activity level are you looking for in an animal?
*
Please Select
Low
Medium
High
Where would the animal be when you are home?
*
Where would the animal be when you are at work?
*
While outside for a period of time would the animal be supervised?
*
Please Select
Yes
No
Please describe how the animal woud be secure while outside
*
What would you do with your animal if you were on vacation?
*
What would you do if you were unable to keep your animal?
*
If you were forced to find a new residence what would you do with your pet(s)?
*
References
Reference #1 Name
*
First Name
Last Name
E-mail
Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Reference #2 Name
*
First Name
Last Name
E-mail
Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Reference #3 Name
*
First Name
Last Name
E-mail
Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Have you ever been charged or convicted with any criminal offence relating to animals or children?
*
Yes
No
Please describe details
Were you referred to FARRM to apply to adopt?
Yes
No
If yes, please provide the name of the person who referred you.
First Name
Last Name
E-mail address of the person who referred you.
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