Adoption Application

Full Name *

First Name Last Name

Primary Phone Number *

Area Code Phone Number

Secondary Phone Number

Area Code Phone Number

Please provide your email address *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Are you interested in a specific dog? If so, which one? What do you like most about him/her?

Are you over 21? *

Yes No

1. All potential adopters must agree to a home visit. This is to ensure that our wards are being adopted into safe homes.

2. Adopting a dog is a meeting of the heart as well as of the mind. It is a lifetime commitment to an animal that will be your loving companion and your best friend. We want to make this decision as easy as possible for you, so if you are not sure you can take such a permanent step, please consider fostering one of our dogs before you adopt to help alleviate the pressure you may feel.

3. We require an adoption fee in the amount of $400 for adult dogs and $450 for puppies upon completion of the above in order to defray the cost of veterinary and foster care. We also require a signed adoption contract.

Completing an application does not guarantee an adoption. We, of course, keep all applications confidential and never sell any names or personal information.

Type of residence: *

House Apartment Condo/Townhouse Mobile Home

How long at present address? *

Do you: *

Own Rent

If renting, provide landlord's name & phone number

What is your place of employment? (please include address and phone number)

How long have you worked there?

Please list name and age of each person living in household, including yourself: *

Is everyone in agreement to adopting? *

Yes No

Is anyone allergic to animals? *

Yes No

Do you have plans to move in the near future? *

Yes No

If you did move, what would you do with animals? *

Does your home have a backyard? *

Yes No

Is your home fenced? *

Yes No

Type of fencing?

Wood Chain Vinyl Other

How tall is fence? *

4 feet 6 feet 8 feet none

Do you have a pool? *

Yes No

Please describe the neighborhood you live in. Ex: town or country, quiet or busy, major roads; traffic, are there a lot of children, dogs etc... *

Please list all dogs you currently own by breed/sex/gender/short description of each dog's personality and temperament.

Current Animals:

Do you have cats? *

yes no

If yes, do they stay

indoors outdoors both

Do you have *

chickens livestock any other animals none

Are all your pets spayed or neutured? *

yes no

If no, please explain why *

How many pets have you owned in the last ten years? *

Where are those pets now? *

Have you ever had to give up a pet? *

yes no

If yes, please explain circumstances *

N/A if no

Have you ever adopted a pet before? *

yes no

If yes, who did you adopt through? *

N/A if no

Who would be responsible for this dog's daily care? *

How many hours a day would this dog be left alone? *

Where will the dog stay when alone? *

Where will the dog stay at night? *

How active is your family? *

very active somewhat active not very active couch potatoes

Will the dog be included in family activities? *

yes no

Does your family participate in water activities? *

yes no

Where will the dog stay during family trips/vacations? *

If you became ill, disabled or died, who will care for this dog? Please provide name, address and phone number. *

Please provide your current vets information.

Vet's Name *

Vet's Phone Number *

Are you able to afford unexpected medical bills for a dog? *

yes no

What do you believe an average yearly cost for medical care to be? *

Please supply two references who are not family members. We will contact both of them.

Reference #1 Name *

Reference #1 Phone Number *

Reference #2 Name *

Reference #2 Phone Number *

Any other comments or information you would like us to know in considering your adoption application?

Please write your name below if you agree with the following statement: I certify that the above information is true and accurate to the best of my knowledge, and I understand that my completion of this form in no way obligates Furry Flights to Freedom to adopt a dog to me. I further understand that in order to complete the adoption process, Furry Flights to Freedom will conduct a home visit.

Name:

Date:

Month Day Year

E-mail