Please provide the following information

Date
First name
Last name
Street address
City
State
Zip code
Work Phone
Home Phone
Cell Phone
E-mail

Occupation:

I am applying for a (select at least one):  Cat    Dog

1. Why do you want to adopt a cat or dog?

2. What circumstances, in your mind, justify getting rid of a cat or a dog?

3. Are you prepared to assume full responsibility for a pet including inoculations, veterinarian care, heartworm preventative, good quality food, licensing, etc.?  Yes or No?

4. Do you have animals in your household at the present?  Yes or No?
    If Yes, continue to “A” below. If No, skip to “B” below.

A. DOGS: How Many   Age(s):    Sex(es):

    CATS: How Many    Age(s):    Sex(es):

    OTHER:  What? How many? Age(s): Sex(es):
    Skip to “C” below.

B. Have you owned a pet before? Yes or No?   
    If Yes, continue to “C” below. If No,  skip to “#5” below.

C. What happened to your last pet?  

5. During the last two years have you:
    (a)  Lost a pet (not through death)? Yes or No? 
    (b)  Had one poisoned? Yes or No? 
    (c)  Had an animal killed by a vehicle? Yes or No?   
    (d)  Had an animal die due to disease? Yes or No?   
          If yes, what did he/she die of?

6. Do you have children at home? Yes or No? 
    Number of children: Sex(es): Age(s):

7. Do you live in a: House     Apartment     Condo     Trailer    Other
    If Other, please explain:

8. Do you own or rent your home?

9. If you rent, can you get written authorization from your landlord  to keep a pet?
    Yes or No? 

    Please note: We require written authorization from your landlord or management company.

    Landlord's name, address and phone number.

10. Do you have a yard? Yes or No? 
     Is it fenced? Yes or No?  If Yes, type and height of fencing?

11. Will this pet be kept  primarily indoor or outdoors? 

      Where will this pet sleep?

12. Do all family/household adults work? Yes or No? 

13. How many hours a day will the pet be alone?

14. What provisions will be made for your pet if nobody is home during the day?
 

15.Would you consider: (check all that apply)
    The opposite sex?    Litter mates or a bonded pair?

    An older pet?   To what age? 

16. Are all members of your household aware that you are considering adopting a pet and in agreement?
     Yes or No? 

17. Are you planning to move in the near future? Yes or No? 

18. Is anyone in your house allergic to animals? Yes or No? 

19. Is this pet going to be a gift? Yes or No? 

     For whom?      Do they know? Yes or No? 

20. Do you understand that this rescued animal will be spayed/neutered?

21. Are you willing to allow a SFAS member to visit your home by appointment? Yes or No? 

22. Who is your veterinarian? 
      Name, address, and phone number:  

23. Do you accept that there will be a fee for each adopted pet? Yes or No? 

Additional Comments:

 

By electronically signing below I am attesting to the truthfulness of my answers. I understand that falsification of any of the above information will be grounds to disallow this adoption. By my signature here, I also authorize St. Francis Animal Sanctuary (SFAS) to contact my veterinarian.

 

Electronic Signature 

 

Please Note: If you are under 21 years of age, a parent or guardian must also sign this application.

If you have any questions, or if we can be of assistance, please do not hesitate to contact us by email or phone (601-222-1927).
We reserve the right to refuse any applicant.