FCHS Adoption Application & Contract

Interested in adopting a: *
Who are you interested in adopting? *
Who are you interested in adopting? *
Who are you interested in adopting? *
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Zip Code *
Phone Number * (Format 555-555-5555)
Alternate Phone Number (Format 555-555-5555)
Email Address *
Are you 18 years or older? * If you are under 18 years old please have a parent or guardian to submit the adoption application with their information.
Please enter your birthdate. *
Do you live in a: *
If you answered "Other" then please explain here.
Is your residence a rental property? *
Landlord's Name *
Landlord's Phone Number *
Will the pet live: *
Will the dog be chained or penned? *
If chained or penned then how long each day?
Do you have a completely fenced yard? *
If yes, what type and height?
On average, how many hours per day will your pet be left alone? *
Please list the ages & relationships of people living in your home. *
Do you own other pets at the current time? *
If yes, please list their names, gender, breeds, and ages.
Are all of your pets spayed/neutered? *
If no, which ones?
Veterinarian's Name *
Veterinarian's Phone Number * (Format 555-555-5555)
Since most shelter animals have unknown backgrounds, are you prepared to take your pet for a complete physical within 72 hours of adoption & provide necessary medical treatment? *
Are you aware that the average pet costs in excess of $500 per year in just food and medical care, and that the average life span is 15 years? *
Are you prepared to care for this pet for the rest of its natural life? *
The answers I have given are complete, true and not misleading in any way. I am authorizing FCHS to contact my landlord and veterinarians. I am aware that FCHS cannot guarantee the health and temperament of the animal. If I can no longer keep this animal I agree to return it to FCHS. By selecting Yes and clicking Submit I am agreeing to this contract agreement. *