Adoption Application

Friends of Rocky Mount Animals (F.O.R. Animals)
PO Box 8766
Rocky Mount, NC 27804


Applicant’s Name*
Date*
Phone: (H)*
Phone: (C)*
Phone: (W)*
Address *
City*
State*
Zip*
eMail*
Why are you choosing to acquire a new pet?
Name of pet(s) you are interested in adopting
What interested you in this/these particular pet(s)?
Are you looking for a Puppy   Dog   
A. age range (min./max.)
B. Sex male   female   
C. weight range (min./max)
D. good with children? yes   not necessarily   
E. good with dogs? yes   not necessarily   
F. good with cats? yes   not necessarily   
G. house-broken? yes   not necessarily   
H. activity level? active   moderate   “couch potato”   
I. personality traits
INDIVIDUALS LIVING IN HOME
Name 1
Age 1
Relationship 1
Name 2
Age 2
Relationship 2
Name 3
Age 3
Relationship 3
Who would have primary responsibility for taking care of your new pet?
Do you/your family reside in house   townhouse   apartment   
Do you own or rent your home? Own   Rent   
How long have you lived at present residence?
Are you/your spouse currently employed? Yes   No   
Place of employment
Work schedule
Does your schedule allow you to go home on breaks? Yes   No   
Approx. how many hours total per day are you away from home?
Which of the following best describes your family’s lifestyle? Active/Outdoorsy (jogging, hiking, etc)    Relaxed/Leisurely (reading, t.v., gardening, etc.)    “on the go”   
very social/entertains company frequently   “home-bodies”/usually home outside of work   travels frequently   
How would you describe your family’s household? Quiet/Relaxed   Active/”busy”   Inside only   
Primarily inside   Outside only   Primarily outside   
Are you looking for a pet for Inside only   Primarily inside   Outside only   
Approximately how many hours/day will your pet spend? Inside   Outside   
Where will your pet be kept while you are away from home?
Where will your pet be kept while you are home?
Where will your pet sleep?
Where will your pet be kept when outside? fenced yard   dog pen   tie out   
free in yard   on leash   
Will your pet have access to dog house   garage   house (doggie door)   
How do you envision spending time with your pet?
What type of exercise do you plan to provide for your pet?
Do you plan to crate-train (for dogs)? Yes   No   
How many hrs./day total will your dog be crated?
Species
Name
Age
Indoor or Outdoor? Indoor   Outdoor   
Spayed/Neutered? Yes   No   
Current Vaccinations? Yes   No   
Heartworm Prevention? Yes   No   
Length of time owned
Current or Previous
Species 2
Name 2
Age 2
Indoor or Outdoor? 2 Indoor   Outdoor   
Spayed/Neutered? 2 Yes   No   
Current Vaccinations? 2 Yes   No   
Heartworm Prevention? 2 Yes   No   
Length of time owned 2
Current or Previous 2
Species 3
Name 3
Age 3
Indoor or Outdoor? 3 Indoor   Outdoor   
Spayed/Neutered? 3 yes   no   
Current Vaccinations? 3 yes   no   
Heartworm Prevention? 3 yes   no   
Length of time owned 3
Current or Previous 3
Please list the name and phone number of your current (or previous) vet clinic*
Vet records are under the name of*
How long have you been/were you a client?*
(if less than 3 yrs., please provide an additional vet)*
Please indicate in which of the following situations you might consider giving up your pet *
allergies (self/ family)   expense   shedding   
children have lost interest in it   no longer have time for it   damages household objects   
moving / new residence won’t allow pets   new marriage / mate doesn’t like pets   other   
REFERENCES
Name 1*
Number 1*
Relationship 1*
Name 2*
Number 2*
Relationship 2*
Anti-spam code*