The Farley Foundation, Inc. - Application for Pet Adoption

Thank you for applying for a rescued pet and for saving a life. Please complete and submit The Farley Foundation Application for Adoption.

Today's date: / MM / DD YYYY
Name of pet desired:
APPLICANT INFORMATION
Name First Last
Date of Birth
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Work Phone: - ### - ### ####
Cell Phone: - ### - ### ####
Number of people in household:
If children are in the household, please list ages and names:
Are you or any member of your household allergic to pets?

Are you or any member of your household allergic to pets? Yes No
Are you presently:

Are you presently: Employed Unemployed Retired Student
How long:
Employer:
CO-APPLICANT INFORMATION
Name First Last
Date of Birth:
Relationship:
Work Phone: - ### - ### ####
Cell Phone: - ### - ### ####
Email
Are you presently:

Are you presently: Employed Unemployed Retired Student
GENERAL INFORMATION
Type of residence:

Type of residence: House Apartment Townhome Condo Mobile Home Farm
Do you own or rent?

Do you own or rent? Own Rent
Are you planning on moving in the next 6 months?

Are you planning on moving in the next 6 months? Yes No
If yes, please note type of residence and general location:
If rental, are pets allowed?

If rental, are pets allowed? Yes No Maybe
Are there size restrictions?

Are there size restrictions? Yes No
Max Size:
Complex name:
Manager/Landord Name:
Complex address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Current housing location:

Current housing location: City/Suburban County/Rural Beach/Lakefront
Type of street:

Type of street: Very busy road Moderate traffic Slight traffic
Speed Limit:
HOUSING YOUR NEW PET
Where will your pet live?

Where will your pet live? Inside only Outside only
Inside (%)
Outside %
Where will the pet spend nights?

Where will the pet spend nights? Family member's bed Pet bed Garage Outside Other/indicate below:
Approximately what is the size of your yard?
Text
Do you have a fenced yard?

Do you have a fenced yard? Yes No
What type of fence & how high?
Do you have an invisible fence?
Will you allow the pet to run loose?

Will you allow the pet to run loose? Yes No
If yes, where?
How many hours per day will the pet be alone?
Do you have a pet door?

Do you have a pet door? Yes No
Where will the pet stay when left alone?

Where will the pet stay when left alone? Fenced yard Outside pen Inside in crate Gated room in house Free range of house Garage Laundry room Other/indicate below Other/indicate below
Describe the activity level in your home:

Describe the activity level in your home: Busy (visits by friends, meetings, children, parties at home) Noisy (TV, stereo, machinery, tools, children playing, dogs barking) Moderate (Normal comings and goings) Quiet (Homebodies, few guests) Other/indicate below: Other/indicate below:
What is your reason for considering this type of pet?

What is your reason for considering this type of pet? Family companion Exercise partner Playmate for children Playmate for current pet(s) Protection or guard dog Service or therapy dog Other/indicate below: Other/indicate below:
Please list 4 characteristics that are specific to the pet for which you are applying (not generic adjectives such as "small, cute, playful, friendly, etc):
In the absence of the primary caregiver, who will care for the pet?
Under what circumstances would you return the pet?

Under what circumstances would you return the pet? New job New baby Divorce Allergies Children lost interest Moving Pet's medical issues Doesn't get along with other pets Behavioral problems Housebreaking issues Too time consuming Aggressive behavior Other/indicate below: Other/indicate below:
Are you willing to take responsibility if this pet acquires an illness or tests positive for heartworms?

Are you willing to take responsibility if this pet acquires an illness or tests positive for heartworms? Yes No
What are your anticipated costs per year for this pet? Please include vetting, grooming, boarding, food, toys, and other supplies (Please include an amount)
What brand of pet food do you feed or will be feeding?
Would you consider obedience training for your new dog?

Would you consider obedience training for your new dog? Yes No
How much time do you anticipate for your new pet to adjust to your home?
How much time at the most will you allow the pet to adjust to your home?
PET INFORMATION
Have you had pets in the last 7 years?

Have you had pets in the last 7 years? Yes No
If yes, please provide name and breed of pet(s) along with age and years owned. Please indicate where each pet is now.
Current or past vet/name of clinic:
Will your dog be on heartworm prevention?

Will your dog be on heartworm prevention? Yes No
If so, which type?
Will your dog be on flea and tick prevention?

Will your dog be on flea and tick prevention? Yes No
If so, which type?
Have you ever had to surrender or rehome an animal?

Have you ever had to surrender or rehome an animal? Yes No
If yes, please explain:
Are you applying to adopt a pet from another rescue?

Are you applying to adopt a pet from another rescue? Yes No
If yes, please specify:
Have you ever adopted a rescue animal?

Have you ever adopted a rescue animal? Yes No
If yes, please animal's name and group's name:
PERSONAL REFERENCES

Please provide two personal references (NOT RELATED)
Name (first reference): First Last
Phone - ### - ### ####
Relationship:
Best time to contact:
Name (second reference): First Last
Phone - ### - ### ####
Relationship:
Best time to contact:
How did you hear about the pet you're requesting to adopt and The Farley Foundation?

How did you hear about the pet you're requesting to adopt and The Farley Foundation? Farley Foundation website - www.FarleyFoundationNC.com Rescue Animal Welfare Group Search Adoption Site Search - PetFinder - Adopt-a-Pet - AllPaws Facebook/Social Media Newspaper Posted Flyers Friend Other/indicate below: Other/indicate below:
Are there any additional comments you'd like to add to your application?
Date / MM / DD YYYY
Text

The Farley Foundation, Inc. - Application for Pet Adoption

The Farley Foundation, Inc. - Application for Pet Adoption

APPLICANT INFORMATION

CO-APPLICANT INFORMATION

GENERAL INFORMATION

HOUSING YOUR NEW PET

PET INFORMATION

PERSONAL REFERENCES