EmailMe Form - DOG ADOPTION FORM

FULL NAME *

YOUR AGE *

CONTACT NUMBER *

YOUR ADDRESS *

Street Address

CITY, STATE ZIP *

EMAIL *

ARE YOU A RENTER? *

DOES YOUR LANDLORD ALLOW PETS? *

LANDLORD'S NAME

LANDLORD'S CONTACT NUMBER *

DOES YOUR HOME OWNERS INSURANCE ALLOW THIS BREED? *

HOUSEHOLD PROFILE

NAMES AND AGES OF ALL OTHER LIVING IN THE HOUSEHOLD: *

example: Joe, age 10

DO YOU HAVE OTHER ANIMALS IN THE HOUSEHOLD?
IF SO, PLEASE LIST THEIR TYPE, BREED(S) AND AGE(S): *

example: beagle, age 3

IF YOU HAVE OTHER ANIMALS IN THE HOUSEHOLD, ARE THEY UP TO DATE ON MEDICAL CARE, SUCH AS VACCINATIONS/TESTINGS ACCORDING TO YOUR VETERINARIAN'S STANDARDS? *

OWNERSHIP QUESTIONS:

VETERINARIAN NAME

VETERINARIAN CONTACT NUMBER *

VETERINARIAN ADDRESS

Street, City, State, Zip Code

THE DOG YOU WANT TO ADOPT WILL NEED ESTABLISHED CARE WITH A VETERINARIAN. IF YOU DO NOT ALREADY HAVE A VETERINARIAN THAT YOU USE, WHAT VETERINARIAN DO YOU PLAN ON USING? *

UNDER WHAT CIRCUMSTANCES WOULD YOU NOT KEEP THE PET? *

IF OTHER PLEASE EXPLAIN

HAVE YOU DONE ANY RESEARCH ON THIS BREED OF DOG AND UNDERSTAND THE RESPONSIBILITIES OF OWNERSHIP? *

ARE YOU AN ACTIVE DUTY MILITARY MEMBER OR VETERAN? *

HAVE YOU EVER BEEN CONVICTED OF A FELONY? *

IF YES, WHEN WAS IT, WHAT WAS THE CHARGE, AND IN WHAT COUNTY? *

Is there a specific animal you are interested in adopting? If so, what is its name? *

I certify that all information provided above is complete and accurate to the best of my knowledge. I understand that any falsified information or omissions will disqualify me from further consideration for adoption of a FCDACS dog. I also understand that a home-visit may be required as a condition of adopting this animal. *

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