Pre-Adopt Application

Note: if you get an error with this Pre-Adopt Form, email info@fayettehumane.org with your phone number and which dog you are interested in.


Full Name:	Date:

Address:

City:	State: Zip:

Home Phone:	Work Phone:

Cell Phone:	Email address:

Including yourself, how many adults in live your household?	Do they all want a dog? Yes No

Do all the adults work outside the home? Yes No	If yes, where will the dog stay while you're at work?

Are there children in the home? Yes No	Ages of Children:

Home Information:

Dwelling Type: House Apartment Condo Other:	If other, please describe:

Do you OWN or RENT? Own Rent	If yes, do you have your landlord's permission to have a pet? Yes No

If yes, Landlord's name and phone #:

If an apartment, what is management's pet policy?

Manager's name and phone #:

Is your backyard fully fenced? Yes No (Under some circumstances, when the foster/owner/rescuer prefers placement in a home with a fenced yard, preference may be given to those homes.)

Your Pets:

Do you presently have any pets? Yes No			Have you previously had a dog? Yes No

Current Dogs:
Name:	Age:	Gender:	Altered? Yes No	How long?	Inside or Outside? In Out
Name:	Age:	Gender:	Altered? Yes No	How long?	Inside or Outside? In Out
Name:	Age:	Gender:	Altered? Yes No	How long?	Inside or Outside? In Out

Previous Dogs:
Name:	Age:	Gender:	Altered? Yes No	What happened/what year?	Inside or Outside? In Out
Name:	Age:	Gender:	Altered? Yes No	What happened/what year?	Inside or Outside? In Out
Name:	Age:	Gender:	Altered? Yes No	What happened/what year?	Inside or Outside? In Out

Have any of your dogs ever had puppies? Yes No			If Yes, for: Fun Profit Show Accident

Is anyone in your family allergic to animals? Yes No

Do you know what heartworm disease is and how to prevent it?

Is your current dog or were your past dogs on heartworm prevention medications? Yes No

Which brand?			How often was it given?

How do you plan to prevent fleas and ticks?

Any other pets? Yes No			Please list:

General Questions:

Who will be responsible for taking care of this dog?

What is your primary reason for adopting a dog: Companion Guard Dog Hunting Dog Watch Dog
Other, please explain:

We may verify previous veterinary histories. Do you give permission to check with your veterinarian? Yes No

Veterinarian's or Clinic Name:	Phone:

Please estimate what you think it costs to provide veterinary care for a healthy dog for 1 year:

Where will this dog be kept most of the time? Indoors In fenced yard In an outdoor pen

Where will this dog sleep? Indoors Outdoors	Where?

Where will the dog be left when he/she is alone? Indoors Outdoors

If outdoors: Yard Outdoors Kennel Garage Other:	If other, where?

When you are home, where will the dog be? Indoors Outdoors	If other, where?

Do you travel a great deal? Yes No	How many hours of socialization per day does a dog need?

Under what circumstances would you not keep the dog?:

Have you ever given an animal away or relinquished an animal to a shelter? Yes No

If yes, what were the circumstances?:

Check the bad habits that bored and ignored dogs ('backyard dogs') often develop: Chewing Barking Digging Hyper Reaction to People/Kids Aggression Escaping From Yard

If you are considering a puppy, please answer the following:
This puppy will probably grow into: A small adult dog A medium-sized adult dog A large adult dog

What would you do if the dog grew larger than you expected?:

List the problems associated with raising a puppy:

Training takes a lot of time and energy. Who will be primarily responsible for its training?

Adoptions may require a home visit prior to placing dogs.	Can we visit you at home before an adoption? Yes No
Please list convenient days and times:

Please keep in mind that there may be several parties interested in the same dog. In that situation, not everyone who has filled out a questionnaire will be called or visited by one of our volunteers. If a home visit is to be scheduled, we will call you beforehand. You may not be contacted for several days.

Do you still want to adopt a dog from us? Yes No	Which dog?

Checking this box and typing my name in the space below (digital signature) indicates that I have read and completed this application fully and to the best of my knowledge and that all information I have provided is truthful and accurate.

Signature:

We apologize if you get an error but we DID receive your application anyway -
please do not fill out more than one!
Thank you.