Are you currently interested in adopting a specific adoptable dog? *
No Yes
Which adoptable dog are you interested in? *
Binx (Dog - 24031)
Dot aka Koda (Dog - 21010)
Grace (Dog - 23092)
Hazel (Dog - 22098)
Hilly aka Opal (Dog - 23074)
Iris (Dog - 23036)
Jake (Dog - 22170)
Jasper (Dog - 24032)
Java (Dog - 24012)
Jupiter (Dog - 20151)
Latte (Dog - 24013)
Leia (Dog - 24020)
Merry (Dog - 24002)
Midnight (Dog - 21056)
Midnight aka Milo (Dog - 22105)
Oscar (Dog - 24036)
Otto (Dog - 22063)
Peter aka Max (Dog - 22003)
Queen (Dog - 23081)
Rocky aka Ace (Dog - 19053)
Roscoe (Dog - 24033)
Roxy (Dog - 23094)
Schulz (Dog - 24034)
Sheba (Dog - 20152)
Sheila aka Havoc (Dog - 23040)
Tyson (Dog - 22117)
Weebles (Dog - 24037)
If not listed, what is the name of the dog? (List N/A if no preference)
If not interested in a particular dog, what type of dog are you seeking?
How did you hear about Furever After Rescue? *
Are you willing to allow a representative of Furever After Rescue, Inc. to visit your home to see where your pet will be living? **Please note: We ask to visit to be sure that the pet you adopt is going to a good home and the pet is a good fit for your lifestyle. *
No Yes
If no, please explain.
Applicant First Name *
Applicant's Last Name *
Street address 1 *
Address Line 2
City *
State *
Zip Code *
Phone Number (Please provide a number that can receive text messages) *
Alternate Phone Number
Email *
Age *
Current Occupation *
How long have you lived at your current residence? *
Do you currently rent or own your residence? *
Rent
Own
If you rent, please provide your landlord's name and phone number.
How many adults (aged 18+) currently reside at home? *
Please provide the first and last names of all adults in the household: *
How many children (aged 0-18) currently live at home? *
If children (aged 0-18)reside in the home, please list their ages. *
Does anyone currently residing in your home have any known allergies to animals? *
No Yes
Which best describes your experience as a pet owner? *
I have never owned a pet
I have owned a pet in the past (Over a year ago)
I have owned a pet in the past year, but do not currently
I currently own a pet
If you currently own a pet(s), what is/are the type(s), breed(s), sex, and approximate age(s) of the animal(s)? **Please type N/A if you do not currently have any pets. *
Are all of your pets spayed and/or neutered? *
No
Yes
I do not currently have a pet.
Are all of your pets currently up-to-date on vaccinations? *
yes| no| I do not currently have a pet
No
Yes
I do not currently have a pet
Are all of your pets current on heartworm prevention and heartworm tested within the last year? *
No
Yes
I do not currently have a pet
Do any other animals live in your home besides those you own (for example a roommate's pet or an animal you are watching for someone else temporarily or for an extended period)? *
No Yes
If yes, please explain.
Have you ever surrendered or given away an animal? *
No Yes
If yes, what were the circumstance(s) that led to the surrender?
Have you ever had to euthanize an animal? *
No Yes
If yes, what were the circumstances?
I want a pet because: *
I want a companion
I want a companion for my pet
I want an animal to breed
I want a guard dog
I want a hunting dog
Other
If other, please explain.
The pet I adopt must be good with: (Please select all that apply) *
Children
Cats
Dogs
Does not matter
Other
If other, please explain.
I have the following at my home: (Check all that apply) *
Fenced-In Yard
Animal Pen in Yard
Chain/Tether
Run Line (Attached to two trees with a tether attached to animal)
None of these
If you have yard fencing, please describe the type.
When I am not at home, my pet will be: *
in the garage
In the yard
Loose outside
Chained/Tethered
In a crate in the house
Confined to one room of the house
Loose in the house
Other
If other, please explain.
When I am at home, my pet will be: *
In the garage
In the yard
Loose outside
Chained/tethered
In a crate in the house
Confined to one room of the house
Loose in the house
Other
If other, please explain.
At night, my pet will sleep: *
In the garage
In the yard
Loose outside
Chained/tethered
In a crate in the house
Confined to one room of the house
Loose in the house
Other
If other, please explain.
Will your schedule change in the near future? (If yes, please mention any work or other schedule changes that will impact the dog's care or time with humans) *
I want a pet that can be alone: *
More than 9 hours a day
4-8 hours a day
Less than 4 hours a day
I want a pet that is by my side: *
All the time
Sometimes
Not too much
I want a pet that likes to be held: *
All the time
Sometimes
Not too much
I want a pet that enjoys being with children: *
All the time
Sometimes
Not too much
I want a pet that likes to be outside: *
All the time
Sometimes
Not too much
I want a pet that is vocal or "talkative": *
All the time
Sometimes
Not too much
I am open to a pet that is part of a bonded pair (2-for-1 adoption). *
No Yes
I am open to adopting a pet with special medical needs. *
No Yes
I am looking for a pet that is playful (with toys, children, people, etc.) *
No Yes
I am open to an older pet (5 years or older) *
No Yes
Which of the following levels of basic manner training would you prefer them to have? (No jumping up, no pulling on leash, no stealing of food, etc.) *
No training
Some training
A lot of training
Does not matter
Which of the following circumstances do you see as being an understandable reason to return or surrender a pet? (Check all that apply) *
The pet is aggressive
You have to move
Your family is expecting a new child
The pet is hard to potty-train
The pet is too playful
The pet has bitten
The pet does not get along with other pets
None of these
Other
If other, please explain.
What are your plans for the dog/puppy if something happens to you (illness, incapacitation, senior living accommodations, accident/personal tragedy, or death) during the dog’s lifetime? *
Will you keep your pet's vaccinations up-to-date? *
No Yes
If you have a current veterinarian, please list his/her name and number (Please also provide contact information for vets of past pets if you have had pets in the past):
Please provide the name and phone number for at least two (2) personal or professional references (non-family references required). *
Comments and/or Questions
I agree that all statements I have made on this form are true. I understand that knowingly giving false information is grounds for denial of application and/or the repossession of the animal if the application has been approved. I understand that Furever After Rescue, Inc. reserves the right to deny any application. *
No Yes
Potential Adopter's Name *
Potential Adopter's Signature *
Clear
Date *