First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Work Phone*
x

Cell Phone*

To be considered for adoption, you must be 18 years of age or older with a valid California driver’s license or other form of identification.*

To the best of your knowledge, has any member of your household ever been convicted of an animal welfare law violation such as neglect, cruelty, abandonment, etc?*
Choose one: Yes No I don't know

Who interests you?*
Choose an animal: Emerald Stormi

He or she must get along with (select all that apply):

Partner or spouse's name*

Preferred contact method*

Name of employer

You are*

What's your occupation?*

In what type of home do you live?*

How long have you lived at your current residence?*

Do you plan to move in the coming year?*

Do you rent or own?*

If you rent, are there rules and restrictions around pet ownership?

Has your landlord given you permission to have a pet?

Please provide your landlord's full name and contact info:

Household activity is usually:*

Number of adults in household:*

Number of hours an adult is usually at home:*

Number and ages of children in household:

Do all members of the household consent to adopting a pet?*

Is anyone in the household allergic to dogs?*

If yes, please explain:

Have you had pets in the past 5 years?*

If yes, do you still have the pet(s)?*

If no, tell us why:*

Please list your current pets. 

Include name, species, gender, and age. I.E. - "Milo (dog), male, age five

Do you have:

Current pet #1

Current pet #2:

Current pet #3:

Current pet #4:

Current pet #5:

I have experience with (select all that apply):

Who (in your household) is responsible for your pet's care?*

If, by chance, the new pet and our resident pet don't get along I will (select all that apply):

Do you have an enclosed room in your home to confine or separate this pet from others if necessary?

Do you have (select all that apply):

Are you willing to work with the dog on basic training?*

What do you see as normal, typical dog/puppy behavioral problems?*

Are you willing to work with your pet on such problems? *

What behavioral issues are a deal breaker for you? What are you unable/unwilling to work with? *

Are you willing to take your dog to training classes if necessary?*

What do you believe are acceptable reasons for giving up a pet? *

Will you take your pet to the vet for annual check ups?*

Are you prepared to cover costs for veterinary expenses ranging from vaccinations to emergency care?*

How much are you prepared to spend each month on food, supplies, and basic care? *

What will you do if the cost of your pet's care exceeds your budget?*

Name of current/past pet's veterinarian:*

What will you do if your pet is severely injured or seriously ill?*

Do you plan to get pet insurance? *

Can we call for a reference?

If you're approved, when are you planning to bring a new pet home?*

PLEASE READ CAREFULLY. Although St. Francis Animal Protection Society does its best to pick out the healthiest of animals rescued, we cannot guarantee the health of the animals offered for adoption. Any time you adopt an animal, you should take it to a licensed veterinarian as soon as possible, in order to start it immediately on a program of preventative vet care. Be aware that the animals available for adoption are rescues and may have been exposed to (or may have) an upper respiratory infection or other illness or diseases. These disorders can have an incubation period of up to several weeks. If the animal you adopt shows signs of illness at any point, you must take it promptly to your veterinarian for treatment at your expense.

Submitting an application is not a guarantee of adoption. Our goal is to find the right match based on what a family is looking for, and what's best for the animal.

I certify that the information entered on this application is true and I have read and understand this disclaimer. Enter your name and today's date.*