Apply

Applicant Information

Application Date

Pet Applying For

Name

Street Address

City

State

Zip / Post Code

Phone

Resident Adults

Type of Home

Own Home

Yes, I own my home

Rent?

Yes, I rent

Applicant's Employer

Spouse's Employer

Is anyone allergic to animals?

Number of Pets currently owned?

Name, Breed and Age of Each?

Are all of your pets up to date on vaccinations? If no, why?

How many pets have you owned in last five years?

What Happened to these pets

Pet Preferences & Care

Who will be primarily responsible for your pet?

What kind of pet are you looking for?

Where will the dog be when you are home?

Where will the dog be when you are not home?

Where will the dog be when you are asleep?

What type of pet do you want? (pick one)

Dog Puppy Cat Kitten

Describe the perfect pet for your family:

Do you believe in hitting (spanking) your pet?

No Yes

If you move, what will you do with your pet?

For what purpose do you want a pet?

Will the dog go to the potty

on a leash? in a fenced yard? In a kennel? on a tether (cable)?

If you go away, will you

board the pet? find a pet sitter? take with you?

Where have your pets gone for veterinary care?

Vet's phone number?

Will you be a new client at this vet?

No Yes

When was your last visit with this vet (if used previously)?

Do you plan to use flea prevention?

yes no

Do you plan to use heartworm prevention?

yes no

How important is it to spay/neuter your pets?

Have you ever surrendered an animal to the Humane Shelter?

yes no

If yes, describe the circumstances that led to the surrender

Behavior & Commitment

Are you willing and able to work with your pet regarding behavior problems, such as:

House breaking

yes no

Adapting to new environment

yes no

Obedience issues

yes no

How will you work on or handle these behaviour problems?

Are you prepared to keep this pet for its lifetime?

yes no

Do you agree to notify St. Francis if you are no longer able to keep and care for this pet?

yes no

Certification & Signature

I CERTIFY THAT THE INFORMATION I HAVE GIVEN IN THIS ADOPTION APPLICATION IS TRUE AND CORRECT. I UNDERSTAND THAT ST. FRANCIS C.A.R.E. HAS THE RIGHT TO DENY ANY APPLICATION FOR ADOPTION FOR ANY REASON. I HEREBY, FOREVER RELEASE, DISCHARGE AND AGREE TO HOLD HARMLESS AND INDEMNIFY ST. FRANCIS C.A.R.E., ITS BOARD OF DIRECTORS, ITS MEMBERS, OFFICERS, AGENTS AND VOLUNTEERS FROM ANY AND ALL CLAIMS, DEMANDS, ACTIONS OR LIABILITIES OF ANY KIND, WHATSOEVER ARISING AS A RESULT OF OR IN CONNECTION WITH ANY ANIMAL I MAY BE ALLOWED TO ADOPT.

Date Signed

Applicant's Signature

Are you 18 years of age or older?

Adoption Form

Applicant Information

Pet Preferences & Care

Behavior & Commitment

Certification & Signature

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