Potential Adopter’s Home Address (Please include City and Zip): *
Your answer
Email Address: *
Your answer
Primary Phone Number: *
Your answer
Secondary Phone Number: *
Your answer
Occupation: *
Your answer
Marital Status: *
Your answer
Spouse’s Name & Occupation:
Your answer
Where do you currently live? *
If applying for a dog what type of fencing does your home have? *
How long have you lived at this address? *
Your answer
If you rent or live in an apartment, is it permissible to have pets in your home?
Your answer
Landlord’s name and phone number:
Your answer
Are you 18 years or older? *
Your answer
Name, Age, Relationship of any other adults living in your home: *
Your answer
Name, Age, Relationship of any children currently living in your home: *
Your answer
List the name, type/breed, age, and gender of any other animals living in the home and how long you’ve had them: *
Your answer
Current Flea and Tick Preventative used: *
Your answer
Current Heartworm Preventative used? *
Your answer
List any pets you’ve owned within the last five years and why you no longer have them (stolen, lost, passed away, gave to friend, etc.): *
Your answer
Briefly describe an average day in your household: *
Your answer
Will this be an indoor or outdoor animal? *
If applying for a cat do you plan on having it declawed? *
What are you willing to spend for annual vet care, including vaccinations? *
Your answer
If you are applying for a dog are you prepared and willing to spend approximately $325 a year on monthly flea and heartworm prevention?
Clear selection
If you are applying for a cat are you prepared and willing to spend approximately $120 a year on monthly flea prevention?
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Primary Veterinarian, Address, Phone Number: *
Your answer
Are your pets current on vaccines? *
Your answer
Are your pets spayed or neutered? *
Your answer
Have you ever adopted from Free to Live in the past? *
If yes, was the adoption a dog or cat? *
What temperament in an adopted dog or cat would best fit your personality and/or lifestyle? *
Your answer
Why did you decide to adopt? *
Your answer
How many hours a day will your pet be left alone? When they are left alone, where will they be? (outside, in a kennel, sleeping in bed, etc.) *
Your answer
Tell us why you would like to adopt this particular animal and why you would be the best family for him or her? (Please include experience as a pet owner, any professional pet care experience, etc.) *
Your answer
Will you allow a Free to Live representative to visit your home? *
Please list the name, phone number, and relationship of three personal references: *
Your answer
A copy of your responses will be emailed to the address you provided.