First Name*

Last Name*

Email*

By selecting yes, you understand and agree that FOBCAS reserves the right to deny any application at any point in the adoption process if we feel that the animal is not a good fit. *

Name:*

Address:*

Primary Number:*

Secondary Number:*

Email:*

Best time to contact:*

Are you 18 years of age or older?*

Are you employed? (If yes, please provide name of employer)*

Please indicate which animal you are interested in adopting?*

Why are you interested in adopting at this time?*

Why did you choose to apply for this particular pet?*

Do you own or rent your home?*

If you rent, have you received the approval of your landlord to have an animal?

If you rent, provide the rental agent's name and telephone number including area code.*

Please list adults residing in your home and relationship to you:*

Do all adults in the home agree to adopting this animal?

Are their children in your household? If yes, what are their ages?*

Who in the household will care for the pet?*

Do you currently have pets in your household?

If yes tell us about them:*

Are these animals spayed/ neutered and up-to-date on vaccinations?*

(Dogs only) Is your dog currently on heart worm preventative?

Will the animal be kept inside or outside?*

How many hours alone will the animal spend alone on average?*

Where will the animal be kept when you are not home?*

Where will the animal be kept when you are home?*

Where will your animal sleep?*

(dog only) Is your yard fenced?

If so what type of fence?*

(dog only) what is height of fence?*

(dog only) if your yard is not fenced, how will you exercise this dog?*

(dog only) Will you be crate training this dog?

(Dogs only) If your new pet is not housebroken, how do you plan to teach them?*

Have you ever given up a pet? If so explain:*

Have you ever been charged with animal cruelty?*

Veterinarian's name and telephone including area code?*

Under what name(s) would this vet office look to give us a reference?

Please provide at least one personal reference that is not a family member (list name, e-mail address, and telephone number including area code).*

Please share with us anything else you wish, which might help us make a decision on the placement and "match making" for an animal to your home.

Please use this space to ask any questions you might have.

Please type your name and date to certify that all information provided is accurate and truthful, and that you have read and agreed to our disclaimer stating that FOBCAS reserves the right to deny any application. *