First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Cell Phone

Date of Birth*

Which animal are you interested in
Choose an animal: Acorn Alani Beatrice Brynn Chloe Cuddles Cyrus Dori (must be adopted with Nemo) Freckles Jo-Jo Julius Kimmy Kris Levi Martin Mischa Moana Mrs. Tabitha Nemo (must be adopted with Dori) Penny Jo Polly Pocket Puma Punkin Riddler Rose Sasha Squiggy Starburst Sylvia Tigerlily Twyla Vinny

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number. If you don't rent, please enter N/A.*

Do you live in association? *
Choose one: Yes No

If yes, what are the rules/restrictions?

How many people reside in your household*

How many adults (18+) are in the home?*
Choose one: 1 2 3 4 or more

Please list first name, last name, & date of birth for any additional adults living in the house hold*

How many children (under 18) are in the home?*
Choose one: None 1 2 3 4 or more

If there are children, please list the ages

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

If you don't have a fenced yard, please describe how you will exercise and confine the animal when outside.

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

For cats only: Are you planning to declaw*
Choose one: Yes No N/A

Where will the animal be kept when you are not home*

How much time will the animal spend alone during the day*

Please list your current pets (Include breed, gender, age)*

Are your current pets up to date on vaccines? If no, please explain*

Are your current pets spayed/neutered? If no, please explain*

Please list the Veterinarian's clinic name that can verify your current pets are UTD and spayed/neutered. (If you do not have pets, please enter N/A.)*

Please provide the veterinarian's phone number that can verify your pets are UTD and spayed/neutered. (If you do not have current pets, answer N/A.)*

Are you willing to have a Fur-Ever Home representative visit your home by appointment?*
Choose one: Yes No

What is the best way to contact you? *Please note we run primarily via email**
Choose one: Call Text Email Facebook

Animals are as individual as people. Are you willing to spend the time and effort to help this pet adjust to your home and lifestyle?*
Choose one: Yes No

List two references (At least one can not be a family member). Include email address or phone number.*

How did you hear about us?

I certify that the information entered on this application is true. Enter your name and date*