St. Francis Animal Sanctuary
Pre Adoption Application

Please provide the following information

Date
First name
Last name
Street address
City
State
Zip code
Work Phone
Home Phone
Cell Phone
E-mail

Occupation:

I am applying for a (select at least one):     Cat    Dog

1. Why do you want to adopt a cat or dog?

2. What circumstances, in your mind, justify getting rid of a cat or a dog?

3. Are you prepared to assume full responsibility for a pet including inoculations, veterinarian care, heartworm preventative, good quality food, licensing, etc.?  yes/no

4. Do you have animals in your household at the present?  yes/no
    If Yes go to A below - If No go to B below.

    A. DOGS: How Many Ages: Sex(es)
         CATS: How Many   Ages: Sex(es)
         OTHER:  What? How many? Age(s) Sex(es)
    Go to "C" below.

B. Have you owned a pet before? Yes/No   If Yes go to "C" / If No go to #5

C. What happened to your last pet?

5. During the last two years have you:
    (a)   lost a pet (not through death)? yes/no
    (b)  had one poisoned? yes/no
    (c)  had an animal killed by a vehicle? yes/no  
    (d) had an animal die due to disease? yes/no  
            If yes, what did he or she die of ?

6. Do you have children at home? yes/no
    Number of children: Sex(es) of children Age(s) of children

7. Do you live in a
              House        Apartment        Condo        Trailer
        Other, Explain

8. Do you own or rent your home?

9. If you rent, can you get written authorization from your landlord  to keep a pet?
    yes/no We require it.
    Landlord's name, address and phone number.

10. Do you have a yard? yes/no
    Is it fenced? yes/no If yes, type and height of fencing?

11. Will this pet be kept  primarily indoor or outdoors? 
        Where will this pet sleep?

12. Do all family/household adults work? yes/no

13. How many hours a day will the pet be alone?

14. What provisions will be made for your pet if nobody is home during the day?
   

15.Would you consider: (check all that apply)
    The opposite sex?    Litter mates or a bonded pair?
    An older pet?   To what age? 

16. Are all members of your household aware that you are considering adopting a pet and in agreement? yes/no

17. Are you planning to move in the near future? yes/no

18. Is anyone in your house allergic to animals? yes/no

19. Is this pet going to be a gift? yes/no
    For whom?      Do they know? yes/no

20. Do you understand that this rescued animal will be spayed/neutered?

21. Are you willing to allow a SFAS member to visit your home by appointment? yes/no

22. Who is your veterinarian? 
    Name, address, and phone number:  

23. Do you accept that there will be a fee for each adopted pet? yes/no

Additional Comments:

By electronically signing below I am attesting to the truthfulness of my answers. I understand that falsification of any of the above information will be grounds to disallow this adoption. By my signature here I also authorize the rescue organization to contact my veterinarian.

Electronic Signature

NOTE: If you are under 21 years of age, a parent or guardian must also sign this application. If you have any questions, or if we can be of assistance, please do not hesitate to call.

We reserve the right to refuse any applicant.