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Friends Of Emma ~ Adoption Application
Personal Information
E-Mail:*
Valid e-mail is required
How did you hear about us?
How can we find you on Facebook?
First Name:*
Last Name:*
Spouse/Partner/Housemate Name:
Address Line 1:*
Address Line 2:
City:*
State:*
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Zip Code:*
How long have you lived at your current address?*
If less than three years, please list previous address?
Marital Status:
Select Status
Single
Married
Divorced
Date of Birth:
Month
January
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Phone:*
Occupation of adult(s) in family?
Place of employment and supervisor contact number(s)?
Time with current employer?
How many children live in the home:*
Ages:
Are there children who visit frequently?
Yes
No
If yes, what are their ages?
How many adults live in the home :*
Do all adults work outside the home:*
Yes
No
Do you:*
Own your property
Rent your property
Live with your parents
If renting, does lease allow for pets?
Yes
No
If renting, please provide landlord`s name and telephone number:
Adoption Related Information
Which pet are you interested in?*
Why are you interested in adopting?*
'29' '99'
Choose Reason(s)
Companion for Myself/Family
Companion for Another Pet
Companion for Friend/Relative
Guard Dog
Hunting
Agility
Family Pet
Child`s Pet
Gift
Other
you may choose more than one
Do you have a fenced in yard?*
Yes
No
Please describe outdoor area for pets.
Do you currently own a pet?*
Yes
No
Please list all companion animals you currently have:
include type of pet & age
Are all animals in the home spayed / neutered?*
Yes
No
If no - why not?
If approved, are you willing to spay/neuter the pet? (if not already done at time of adoption)*
Yes
No
Where will this pet spend most of it`s time?*
Select spend time
Indoor Only
Mostly Indoor w/some Outdoor
Indoor/Outdoor
Mostly Outdoor w/some Indoor
Oudoor Only
How many hours a day will your new pet be without human companionship?*
Healthy pets usually require a MINIMUM cost of $500 per year for general veterinary care, food, and other related expenses.
Are you willing and able to afford these costs?*
Yes
No
Name, address, and phone number of your Veterinarian:*
Have you ever had to give up or find another home for a pet in the past?*
Yes
No
If yes, please explain.
Are you committed to caring for this pet for its LIFETIME?*
Choose a Are you committed to caring for this pet for its LIFETIME?
YES - Unconditionally!
As long as he / she stays healthy.
As long as my living situation allows.
I may have to re-home in the future.
Many of our animals require ongoing special care - temporarily or throughout their lifetime.
Do you have experience with special needs animals?*
Yes
No
If yes, please explain.
Training is vital for a happy, well rounded dog and family!
Are you willing to take your new pet through a local basic training program?*
Yes
No
If yes - please tell us where / with whom? (i.e., PetSmart training, local trainer, etc.)
If no - why not?
Please provide the names, addresses and telephone numbers for two personal references:*
Please provide additional information about your interest:
If approved, will you require air delivery of your new pet? (additional fees apply)*
Yes
No
from Fort Worth, TX
Thank you for your interest … if approved, you will be contacted shortly.
Stay up to date with all of our rescue efforts by following our Facebook Page:
Emma Cleft Palate Chihuahua
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