Please fill out form completely, if there is a question that does not pertain to you just put
n/a in the box provided. Thank you so much for choosing adoption! These animals deserve it!!
FTAR ADOPTION APPLICATION
*Household Information*
Name: _________________________________________________
DOB:____________ DL#:_______________St:_____
Address:________________________________________________________________
City:___________________________________St:_______ Zip:________________
Home Phone:________________________ Cell:__________________________
Email:___________________________________________________________________
Do you live in: [ ]Apartment [ ]Town home [ ]Mobile home [ ]House
[ ]Other _________________________________________
Do you rent? (Y / N) If yes, please provide the following information:
Landlord/ Rental Company:_________________________________
Phone: _________________
How long have you lived at this residence? Years_______ Months______
If renting: Does your landlord or complex allow pets? (Y / N)
Is there a weight limit? (Y / N) If yes: How much? ___________Pounds
Is a pet deposit required? (Y / N Is there a breed restriction? (Y / N)
If yes: Can proof of deposit be obtained from your landlord? (Y / N)
If no, why not? ________________________________________________________________________
Do you plan to move in the next 12 months? (Y / N)
Do you have a fenced yard? (Y / N) Height __ft
Type of Fence: [ ]Wood [ ]Chain Link [ ]Other____
*Employment Information*
Employer: _____________________________________ City: _____________________
Work Phone # _________________________ Spouse’s
Name__________________________ Employer ________________________
Work Phone # _________________________
*Questionnaire*
Have you ever been convicted or accused of Animal Cruelty/ Neglect? If so, please
explain:________________________________________________________________________________________
__________________________________________________________________
Do you have experience with house training and crate training? (Y / N)
Have you had experience with a shelter pet and what behavioral issues they may have? (Y / N)
How many people live in your house over the age of 18? _______ Under 18? _______
Please list all members and ages:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
___
Are you or your spouse a student? (Y / N) Full time / Part time
Do you travel frequently? (Y / N) If yes, who will care for your pet(s)?
_______________________________________________________________________________________________
_________________________________________________
Does anyone living in your household have allergies to dogs? (Y / N)
Does anyone living in your household have asthma? (Y / N)
Have you ever given an animal up for (adoption/ rehomed/ turned over to animal welfare?
(Y / N) if yes, why?_______________________________________________________
Are all pets in your household current on the following:
Vaccinations? (Y / N) Heartworm preventative? (Y / N)
Have any pets in your home, now or in the past, been diagnosed with an infectious disease?
(Y / N)
Which diseases? (Fel Leuk/ FIP/ FIV/ Heartworms/ Distemper/ Parvo/ Coccidia/ Mange )
If yes, was the disease treated, and how long ago?__________________________________
Would you use a tie out/chain to keep the animal in the yard? (Y / N)
Would the dog ride in the back of a truck? (Y / N) Is there a camper top on the truck? (Y / N)
The pet I am adopting will be kept: [ ] Totally Inside [ ] Mostly Inside [ ] Mostly Outside [ ] Totally
Outside.
While I am at work, the pet will be kept ______________________________
While working, I am gone _______ hours a day and my spouse is gone _________hours.
Do you come home for lunch? (Y / N)
Where will the pet will sleep? _________________________
Please list all cats and dogs you have owned and currently own:
SPAYED/NEUTER WHERE IS THE
NAME AGE TYPE OF PET
ED ANIMAL NOW?
Please explain here if any of your current animals are not spayed or neutered:
_____________________________________________________________
Do your current animals get along with other animals: (Y / N)
if no, please explain how this will be handled:
________________________________________________________________________
How does your current dog get exercise?
[ ] Daily Walks [ ] Backyard play [ ] Dog Park [ ] Other:__________________
Number of pets NOT CURRENTLY OWNED, but owned within the last 5 years:
Dogs________ Cats ________ Other Species ___________________
What happened to these pets and why do you not have them anymore?
______________________________________________________________________________________
*References*
NAME PHONE NUMBER NUMBER OF YEARS RELATIONSHIP (NOT
KNOW RELATED PLEASE)
1.
2.
3.
Please list your current Veterinarian:
Name:__________________________________________
How long have you used them? ________Phone:_______________
If less than 1 year please provide previous Veterinarian information:
Name:__________________________________________
How long have you used them? ________Phone:_______________
*Comments*
If there is something that we did not cover, or you would like to explain further please put all
comments/concerns in this section:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
___________________________________________________________________________Disclaimer
(Please initial and sign statement)
I have read the above information carefully and have filled out this application honestly. I
understand that omission of information and/or failure to answer all questions and sign the
application can result in this application being declined. If an omission or untruth is discovered
after an animal is placed in your care, I understand that FTAR reserves the right to annul the
adoption and reclaim the animal. I give Forgotten Tails Animal Rescue/ Bully Breed Humane
Society permission to fully investigate the information provided and contact all references
listed on this application. If the application passes this review, I agree to a home and yard visit
on a mutually agreed date by a FTAR/ BBHS volunteer before a decision is made.___________
______________________ _______________________ ___________________
Full Name Signature Date
FTAR Staff Only:
I have verified references and reviewed this application______
I have performed a home check of the potential adopter______
I have (approved / NOT approved) applicant to adopt an animal from FTAR_______
I have contacted the potential adopter with the disposition of this
application/agreement._______
Notes:
______________________________________________________________________________
__________________________________________________________________
