Pre Adoption Application

I am over 21 years old *

I understand that FAHS reserves the right to refuse the adoption of any animal *

If renting, you can provide a paid receipt for a pet deposit and or have written consent from landlord allowing pets in home

By checking this box, you authorize your veterinarian to provide the Florence Area Humane Society with a history that reflects adequate & responsible care of your animals.

Current or previous veterinarians name, address, phone number

Veterinary records are in the name of?

Name of Pet or Pets You Are Interested In? *

Your First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Email Address *

Home Phone Number

Cell Phone Number

Have You Owned A Pet Before? *

If Yes, What Types Of Pets and Where Are They Now?

How Many Cats Do You Currently Have? List Names, Ages and If Spayed or Neutered.

How Many Dogs Do You Currently Have? List Names, Ages and If Spayed or Neutered.

How Many Other Animals (Not Dog or Cat)Do You Currently Have? List All That Apply.

Have You Adopted From FAHS or Other Shelters Before?

If Yes, From What Agency And When?

Have You Ever Surrendered An Animal To A Shelter Before? *

If Yes, When And What Was The Reason?

Regarding Your Home, Select All Options That Apply: *

If Renting, provide your landlords name and contact phone number.

Are You Planning To Move In The Next 6 Months? *

If Yes, What Will You Do With Your Pet?

Are There Children Living In The Home? *

If Yes, What Are The Ages Of Each Child.

Are There Children That May Not Live In The Home, But Do Visit? *

If Yes, What Ages Are The Children And How Often Do They Visit?

Does Anyone In The Home Have Animal Allergies? *

Select All That Apply, Where Will The Pet Be Kept Primarily? *

How Will The Pet Be Confined To Your Property When Outside? Select All That Apply: *

How Much Time Will The Pet Spend With No One Home? *

1-4 HOURS
5-10 HOURS
SOMEONE IS ALWAYS HOME
OTHER

Where Will Your Pet Stay When You Are Not Home? *

Where Will The Pet Stay At Night Time? *

Select All That Apply: This Animal Is For... *

You Understand That Additional Expenses Come With Having A Pet Because They Require: veterinary care, heart worm prevention, flea prevention, grooming, food, sometimes emergency care for anywhere from 10-15 years. Can You Afford These For The Life Of Your Pet? *

Yes
No
Unsure
Had Not Thought About Additional Expenses

Pets Making The Transition From Shelter To New Home Need Time To Adjust To A New Family & May Require House Training & Behavior Training. Are You Willing To Work With These Issues & Provide The Needed Support To Your Pet? *

What Behavior From Your Pet Would You Be Unwilling To Work With? *

What Reasons Might Cause You To Return This Pet? *

By Checking This Box, I Certify That The Information I Have Provided Is Accurate and Truthful. If For Any Reason It Is Determined That Any Questions Were Not Answered Truthfully I Understand My Application Will Immediately Be Denied. *