CONTACT INFO

Name*

First NameLast Name

Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Animal of interest, or type of animal interested in (cat, dog, age, gender, name of animal at the rescue)*

1.Are you at least 21 years of age? *

YesNo

2. Do you rent or own? If rent, please provide landlord name and contact information*

3. Is this pet a gift?*

YesNo

4. How long have you been at your current residence?*

YearsMonths

5. Will you assume full financial responsibility for your pet? *

YesNo

6. Will you take your pet to the veterinarian within 30 days of adoption and regularly thereafter?*

YesNo

7. Do you object to our visiting your home or calling presently or in the future? *

YesNo

8. Why do you want a pet? *

9. How many pets have you had in the last 10 years?*

10. If not still with you, what happened? *

11. If still with you, breed/gender/age? *

12. Are all of your pets spayed/neutered? *

YesNo

13. Are each of the current pets in your home up to date on vaccinations and heartworm and flea/tick prevention?*

YesNo

Many vets require that permission be given before sharing information with rescues and other outside parties. Please call the listed veterinarians and make sure they are authorized to speak with Fur-get Me Not Rescue as it will make things go more quickly in processing your application.

14. List your current veterinarian (or the last you used) and contact information:*

15. List the name and contact information of two pet references (someone who knows how you treat pets):*

15. Are your pets inside or outside? *

InsideOutside

17. What is your occupation and where do you work? *

18. How many hours will your pet be left alone daily?*

19. Where will your pet stay when you are not at home?*

20. Where will your new pet sleep?*

21. Who will care for your pet if you are on vacation?*

22. Does anyone in your home have an allergy to animals? If so, please elaborate: *

23. List all residents of the home and ages. Be sure to include children.*

24. Have the children been around pets? *

YesNoN/A

25. What will you do if your new pet claws or chews your furniture and shows other signs of destructive behavior? *

26. What animal behavior would you be unwilling to work with? *

27. What are your thoughts on declawing cats?*

28. Will cat be kept indoors at all times?*

29. Do you have a fenced yard, and if so, type and size?*

30. Are you willing-and able-to leash walk your dog? *

YesNo

31. Will this be an inside or outside dog? *

InsideOutside

32. Will you keep a collar with ID tags on your pet at all times? *

YesNo

There is a 2-4 day waiting period before adoption is finalized to ensure adequate evaluation time and also to eliminate spur-of-the-moment decisions to adopt. Waiting 2-4 days before finalization allows you, the applicant, time to reflect on your decision to adopt to eliminate a poor experience for the animals and for the adopting families. The animal's welfare is our primary concern.

I CERTIFY THE ABOVE INFORMATION IS TRUE AND THAT ANY FALSE INFORMATION WILL RESULT IN NULLIFICATION OF THIS ADOPTION AND FURTHER ACTION