Wufoo

FURS Adoption Application

FURS is committed to finding permanent, responsible and loving homes for our rescued dogs. FURS reserves the right to adopt only to suitable homes based on the applicant's history and other factors as descibed below. Potential adopters must complete the following application and submit for adoption consideration. If an application is approved a home visit is required by a FURS volunteer. Please answer all questions and be as complete as possible.

Name *
Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Email *
FURS Counselor
Name of Dog Applying on
Household Information
Marital Status
If single, do you live? Alone With Family With Roommate(s)
If you live with Roommates, how many?
Do your roommates have pets? Yes No
If yes, what kind of pet and how many?
Are you a student? Yes No
Do you work? Yes No
What are your typical work hours?
If married, what are your spouse's typical work hours?
Does your job involve travel? If so approximately how many days per month on average?
Does anyone in your household have allergies? Yes No
Number of people in your household over 18 years of age:
Number of people in household under 18 (please list ages)
Do you anticipate any major lifestyle changes (moving, new baby, job change, marriage) in the next two years? If so, please explain.
Who will primarily be responsible for the dog?
Residence Information
Type of residence: house/apartment/condo/mobile home/other
Do you rent or own? Own Rent
If you rent, provide your Landlord's name and phone number (we will contact your landlord so you must include phone number)
If you rent, does your building allow dogs? Yes No
If you rent, please note any weight limits or breed restrictions
Does your residence have a fenced in yard? Yes No
If you have a fence, what type of fence is it and what is its height?
If you do not have a fence, would you consider one? Yes No
If you do not have a fenced in yard, how will you secure your dog when it is outside?
Are you willing to crate your dog for short periods of time when you are not at home? Yes No
Where will your dog be during the day?
Where will your dog be at night?
Where will your dog sleep?
How many hours a day will the dog be alone (without humans at home)?
What is your plan for housebreaking?
Pet Ownership History
Do you currently own pets? Yes No
# of dogs currently owned
# of cats currently owned
other pets currently owned (# and kind)
How long have you owned these pets?
Name of your Veterinarian (Note: if you do not own a pet now but did previously, please put the name of the vet you used with your previous animals)
Phone number of your Veterinarian
Are your pets spayed or neutered?
Is your current dog (or was your previous dog) on heartworm preventative?
If yes, what brand of heartworm preventative do you purchase?
How might your current pets react to a new dog?
If you do not currently own a pet, have you owned a pet before? Yes No
If yes, what kind of pet did you own?
What happened to that pet?
Have you ever turned any animals in to an animal shelter? Yes No
If so, why?
Have you ever been reported to animal control? Yes No
If so, why?
Have you or anyone in your household been charged with animal cruelty, neglect, or the like? If so, please explain
Life with your new dog
What attracted you to this particular dog?
Why is this a good time for you to adopt a dog?
What dog behavior would you find unacceptable?
What would you do if your new dog exhibited these behaviors?
Are you aware that annual routine vet expenses for a dog can range from $200-$300? Yes No
Are you aware that a dog may live to be anywhere between 10 and 20 years old? Yes No
Adopting a dog is a major commitment. Ask yourself: Am I willing and able to care for and love this dog for its entire life? Yes No
Personal References

Please provide the names and phone numbers of two personal references (other than your current or previous veterinarian)
Name of Reference #1
Your relationship to Reference #1?
Phone number of Reference #1
Name of Reference #2
Your relationship to Reference #2?
Phone number of Reference #2
Please read carefully prior to submitting this application

By submitting this application you certify that the above information is true and recognize that any misrepresentation of facts will result in loss of adoption privileges. You authorize FURS to investigate all statements provided in this application and understand that all people referenced in this application may be contacted. FURS reserves the right to deny adoption to any home where they do not believe the dog is a correct fit and to anyone who, in their opinion, will not provide a responsible, loving and permanent home for the above mentioned dog.
Thank you for your application - a FURS volunteer will contact you as soon as possible to discuss.
Do Not Fill This Out

Wufoo

FURS Adoption Application

Household Information

Residence Information

Pet Ownership History

Life with your new dog

Personal References

Please read carefully prior to submitting this application