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Furever Safe Adoption Application
Application to adopt a dog.
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* Indicates required question
Name of Dog(s) applying for:
*
Your answer
Applicant's Name:
*
Your answer
Home Phone:
*
Your answer
Work Phone:
*
Your answer
Address
*
Your answer
City
*
Your answer
State:
*
Your answer
Zip:
*
Your answer
Email Address
*
Your answer
List Types of Pets Owned in the past three years (Type, Sex, Age, Altered?, What happened to it?.
Your answer
Vet Reference, Name and Address
Your answer
Why do you want to adopt a dog?
*
Companion
Guard
To Hunt
Protection
For Children
Other:
Number of Adults in your family/household?
Your answer
Ages of Children under 18:
Your answer
Does any family member have allergies to any animals?
Yes
No
Clear selection
Who will be responsible for this animal?
Your answer
Do you understand that some dogs may not be housebroken and that changing the environment of the dog may cause the dog to have accidents and/or destroy household items?
Yes
No
Clear selection
Are you willing to housebreak and train the dog?
Yes
No
Clear selection
If a disciplinary or behavioral problem arises with the dog what steps will you take to work on it?
Your answer
How many hours will this dog be alone per day?
Your answer
Do you live in a:
House
Townhouse
Apartment
Duplex
Trailer
Clear selection
Do you:
Own
Rent
Clear selection
Do you?
Have Roommates?
Live with parents?
Other:
If you rent, can you get written permission to have a dog?
Yes
No
Clear selection
Are you familiar with local animal ordinances?
Yes
No
Clear selection
Where will this pet be kept during the day?
Your answer
Do you plan to chain the dog outside at any time? If yes please explain.
Your answer
Do you have a fenced yard?
Yes
No
Clear selection
What type of fence? Height?
Your answer
When you go on vacation who will care for the dog?
Your answer
If you move do you plan to take this dog with you?
Yes
No
Clear selection
What will it cost to care for, vaccinate and license this dog each year?
Your answer
Your Occupations?
Your answer
Are you:
Military?
Student?
Other:
Clear selection
Please provide 3 personal references:
*
Your answer
How did you hear about us?
Your answer
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