Animal Adoption Application

1
Your Name:* This field is required.
First Name
Last Name
2
Name of pet you wish to adopt:
3
Age of animal you wish to adopt: * This field is required.
Please Select
Please Select
Kitten
Teenager
Adult
4
Address:* This field is required.Please include county too.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
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
5
Home Phone Number:
Area Code
Phone Number
6
Cell Phone Number:* This field is required.
Area Code
Phone Number
7
Email Address:* This field is required.
example@example.com
8
How old are you?* This field is required.
9
Reference #1 Name:* This field is required.
First Name
Last Name
10
Relationship to you:* This field is required.
11
Reference #1 Phone Number:* This field is required.
Area Code
Phone Number
12
Reference #2 Name:* This field is required.
First Name
Last Name
13
Relationship to you:* This field is required.
14
Reference #2 Phone Number:* This field is required.
Area Code
Phone Number
15
Do you Rent or Own? * This field is required.
Please Select
Please Select
Rent
Own
16
Landlord's Name, if applicable:
17
Landlord's Phone Number:
Area Code
Phone Number
18
Number of Adults and Children in Your Household:* This field is required.
Adults
Children
19
Do any family members have allergies to animals?* This field is required.
YESNO
20
Have you adopted from us before? If so, when?* This field is required.
21
Name of Current Veterinarian or Clinic: * This field is required.If you do not currently have any pets, please list the veterinarian you plan to use once you bring your new pet home:
22
Veterinarian's Phone Number:* This field is required.
Area Code
Phone Number
23
How many pets do you currently own?* This field is required.
24
Name of Pet #1:
25
Type of Pet #1:
Please Select
Please Select
Dog
Cat
other
26
Sex of Pet #1:
Please Select
Please Select
Male
Female
27
Spayed/Neutered?
Please Select
Please Select
Yes
No
28
Name of Pet #2:
29
Type of Pet #2:
Please Select
Please Select
Dog
Cat
other
30
Sex of Pet #2:
Please Select
Please Select
Male
Female
31
Spayed/Neutered?
Please Select
Please Select
Yes
No
32
Name of Pet #3:
33
Type of Pet #3:
34
Sex of Pet #3:
35
Spayed/Neutered?
36
Name of Pet #4:
37
Type of Pet #4:
38
Sex of Pet #4:
39
Spayed/Neutered?
40
Are you willing to submit to a home check?* This field is required.
YESNO
41
Do you have thoughts or plans to declaw or crop the ears of your new pet?* This field is required.
YESNO
42
Have you ever had to give away a pet before? If yes, please explain.* This field is required.
43
Under what circumstances would you give up an animal? (There is an 'other' option if your reason isn't listed.)* This field is required.
Moving
Behavioral Issues
Medical Issues
Don't have the time to care for it
New baby/pet doesn't like it
None
Other
44
Will this animal be indoor, outdoor, or both?* This field is required.
Indoor
Outdoor
Both
Type option 4
45
How often will your new pet receive medical care?* This field is required.
46
How long are you willing to give this animal to adjust to your home?* This field is required.
A week
A month
A few months
6+ months
47
Do you have a plan for your animals if something were to happen to you? If so, what is it?* This field is required.
48
Where did you hear about this animal?* This field is required.
49
In order to be eligible to adopt an animal from our shelter, you must read and agree to ALL of the following: - I will contact Falcon Animal Rescue to make arrangements to return my pet if I can no longer care for it at any point in the animal's lifetime. However, NO REFUND will be given upon the animal's return regardless of the circumstances. - I understand that all efforts are made to assure that the animals are in good health when adopted out but it is possible that an undetectable illness or condition may become present after the time of adoption and it is my responsibility to cover the cost and care of such situations. - I understand there is no guarantee as to the age, behavior, breed, health, temperament or full size of adopted animals. - I understand that adult animals are spayed/neutered, fully vaccinated, flea treated and dewormed, and tested for FeLV/FIV or heartworm disease before the time of adoption. - I understand that kittens/puppies will be spayed/neutered, tested if applicable, flea treated and dewormed, and given there first vaccine before being adopted. If kitten/puppy is adopted before completion of their vaccine series, appointments will be scheduled ahead of time to return to the shelter for booster shots. - I agree to give my new pet adequate time to adjust to his/her new home and surroundings, even if it takes several months. -I agree to provice veterinary care to my adopted pet no less than once per year for the extent of his/her lifetime. - I understand NO ANIMAL adopted from Falcon Animal Rescue shall be declawed or cosmetically altered in ANY way, and I understand the cruelty of these procedures. -I understand Falcon Animal Rescue reserves the right to refuse adoption for any reason at any time. -I agree to provide my own carrier to take my cat/kitten home in. -I understand that Falcon Animal Rescue reserves the right to reclaim adopted pet at any time if conditions of this agreement are not met. * By signing below, I agree, understand, and have read all the above statements: * This field is required.Please Provide Electronic Signature Below:
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50
Please verify that you are human* This field is required.
51
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