Name (please print)_____________________________________________ Date _______

Address___________________________________________________________

City______________________________ State______ Zip___________

Home phone_______________________ Work phone_______________________

Driver's license #______________________ State_______ Date of birth__________

Our goal is to find permanent loving homes for animals. We evaluate the animals to make sure they will be suitable family pets. The purpose of this form is to help us evaluate the people as responsible pet owners.

When you leave Fayetteville, will the pet go with you?________________

Have you adopted an animal from the Fayetteville Animal Shelter before?

If so, when?_________________What kind?_________________________________

Do you still have this pet?____________If not, why not?__________________

______________________________________________________________________________

Do you have children at home?____________What age(s)?________________________________

Is anyone in the house allergic to animals?______________________

Is this pet going to be a gift?________ For whom?____________________________

Is someone at home during the day?___________________________

What kind(s)?___________________________________

Do you still have them?___________ If not, why not?__________________________

Are they vaccinated (rabies, distemper, parvovirus, etc.)?_____________

Are they spayed or neutered?__________ If not, why not?___________________________

Who is your veterinarian?_______________________________________

I authorize Fayetteville Animal Services to obtain my animal's medical records from my veterinarian.

• Yes___________
• No____________

The City of Fayetteville has a leash law for cats and dogs. Do you understand the law?________________

A copy of the leash law is attached.

Do you want an indoor or outdoor pet?__________________________

How many hours a day will the pet be at home alone?___________

Are you willing to provide special training for behavior problems of your pet?___________________________________

Take a look at some of the problems you may have with your pet:

• Dogs: digging barking, jumping up on people, shedding, chewing, jumping fences, messing in house, fleas and ticks, nipping at heels, biting, fearfulness, aggressiveness
• Cats: scratching or biting people, shedding, spraying, jumping on counters or tables, fleas and ticks, scratching furniture, not using litter box, meowing too much

Why do you want to adopt this animal?_______________________________

Name____________________________________

Address______________________________

Telephone____________________________

Name_________________________________

Address______________________________

Telephone____________________________

Do you own or rent?________________

If you are renting, are pets permitted?____________

Does your landlord approve of your plans to adopt a pet?_____________

Landlord's name______________________________________

and phone number_____________________________________

If so, please describe it:______________________________________________

What sort of protection is there from sun, rain, snow, cold winds?________________________________

Will your pet have constant access to fresh, clean water?___________

1. Animals are different from human beings in their responses to human actions.
2. The actions of animals can be unpredictable.
3. Animals should be closely supervised when they are with children.
4. An animal's behavior may change after the animal leaves the shelter.
5. Fayetteville Animal Services makes no claims as to the temperament, health, or mental disposition of any animal put up for adoption.

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