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ADOPTION APPLICATION

Please print and mail or fax to: 901-854-2375

     PUPPY         KITTEN         DOG         CAT

FAYETTE COUNTY ANIMAL RESCUE

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2

 

 

 

Identification Tag Number

Date        /      /

Sng..Adopt.

Dbl.Adopt.

AGE

 

 

 

 

 

1

    |    |    |    |    |    |

 

 

 

 

2

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Day

Time

BREED

COLOR

 

 

 

 

 

 

SEX

 

 

 

 

 

Size: S___  M___  L___

SPAY/ NEUTER

 

 

   □MR.        □MRS.        □MS.        □MISS        □MR.&MRS.

 

 

□ PURE                      

□ MIX

 

 

 

ADOPTER’S LAST NAME

FIRST NAME

STREET ADDRESS

APT.#

CITY

STATE           ZIP CODE

E-MAIL ADDRESS

 

HOME PHONE

(         )        -  

BUSINESS PHONE

(         )        -  

 

 

PET’S NAME

 

 

 

 

 

 

 

 

 

             

 

.

 

 

 

 

 

 

 

 

X________________________

 

.

NAME OF REFERENCE

ADDRESS

CITY

STATE

PHONE

 

 

 

 

 

 

 (       )

 

 

 

 

 

 

 (       )

     

        

 

 

 

 

 (       )

 

1.

 WHO IS THE PET FOR?  Self □     Gift □      For Whom?_______________________ Adopter’s Age________

2.

 IF YOU’RE SINGLE:     Do you live alone? Yes □    No □           Do you live with family? Yes □  No □ 

 Do you work: Yes □  No □        What are your hours:____________________________________________

 IF YOU ARE MARRIED:  Do both work?  Yes □ No □  Husband’s Hours:__________ Wife’s hours:_______

 How many children at home?_________________   Ages ­­­________, ________, ________, ________, ________

 Who will be responsible for the pet: Husband □   Wife □   Children □  Other______________________________

3.

 DO YOU: OWN      RENT        HOUSE       APT.       Floor#______ Elevator in the building?  Yes □  No □

 If renting, does your lease allow pets? Yes □ No □    Are you moving: Yes □  No □   When_________________

 Do you have use of a private yard? Yes □  No □   Is it fenced: Yes □  No □   Fence Height:_________________

Where will your pet be kept:_____________________/___________________ Any allergy to pets? Yes □ No □                                                                                                                                                                                                                                    DAY TIME                                      NIGHT TIME

4.

 DO YOU HAVE OTHER PETS NOW: Yes □  No □  Breed:_________________________________________

 Where did you get the pet:  _____________________________ How long have you had it:__________________

 HAVE YOU EVER HAD A PET BEFORE: Yes □  No □  Breed:____________________________________

 How long did you have the pet:____________________ What happened to the pet:________________________

 Have you ever adopted from FCAR: Yes □  No □   Where is the pet now:________________________________

5.

 YOUR OCCUPATION: ________________________________    Business Phone: (        )       -

 Company: _____________________________________________  Supervisor’s Name: ____________________

 VET’S

 NAME

 CITY,STATE

 PHONE NUMBER

I ACCEPT THE TERMS OF THE ADOPTION AGREEMENT  THIS APPLICATION IS A PART OF THE ADOPTION AGREEMENT.  IF THIS APPLICATION CONTAINS ANY FALSE OR MISLEADING INFORMATION, FCAR SHALL BE ENTITLED TO RECLAIM THE ANIMAL AND EXERCISE ALL OF ITS OTHER RIGHTS AND REMEDIES STATED IN THE ADOPTION AGREEMENT.

 

 

  X ______________________________________

                                         ADOPTER’S SIGNATURE

Reason for rejection

 

 

 

MANAGER REVIEW

 

 

MANAGER APPROVAL T/D

Free 30 Day Care Provided at FCAR Clinic.

Adopter’s Initials