First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
County
Email*
Home Phone
Work Phone x
Cell Phone
Alt Email
Enter the name of the animal you wish to adopt:
Cat or Kitten? Choose one: Cat Kitten
What is your date of birth?
Do you own or rent your home Choose one: Rent Own
What is the name of your apartment complex?
How long at your home address?
If you rent, please enter your landlord's name and phone number.
If you rent, do you have the landlord's permission to have this animal? Choose one: Yes No
How many children are in the household?
What are the ages of children in your household?
How many hours will the animal be alone during the day (include work, school, volunteering, errands, etc.)?
How will you provide for the animal while you are away (travel, work, etc.)?
Who is your veterinarian?
What is your veterinarian's phone number?
Have you previously owned animals? Choose one: Yes No
If Yes, what (Ctrl-click to select multiple)? Choose all that apply: Dog Cat Other
What happened to your animal(s)?
Briefly describe why you are interested in adopting this animal:
Where will the animal be kept when you are home?
Where will the animal sleep?
If applying to adopt a dog, how will you keep the dog confined to your property?
If adopting a cat, how will it be prevented from clawing on the furniture and carpet?
Do you know what the traditional declaw procedure entails? Choose one: Yes No
Will the cat be allowed outside? Choose one: Yes No
If allowed outside, under what curcumstances?
Friends For Life Animal Haven reserves the right to conduct a home visit and contact your veterinarian before approving an adoption. if this adoption is approved, follow-up contact will be made to ensure the adoption experience was a success. I certify the information given on this application is true and complete to the best of my knowledge. I also understand that falsified information or significant omissions may disqualify me from further consideration for adoption of a Friends For Life Animal Haven animal. Please write your full name and today's date.*
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