FCHS Adoption Application & Contract

Interested in adopting a: *

Who are you interested in adopting?

Applicant's First Name *

Applicant's Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Alternate Phone Number

Email Address *

Are you 18 years or older? *

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 *

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. *