F.A.C.E.S., Inc
Dog Rescue & Adoption
P.O. Box 704
W. Spfld,MA 01090

We sincerly hope we can be of service to you. We ask that you fill out this application completely. It is designed to help us find a permanent, loving, responsible home, with consideration not only for the best interest of the dog but the owner and their lifestyle as well.


  Name     Email    
  Address      City     State      Zip    
  Home Phone 
  Your Occupation    Business Phone    
  Name of additional responsible adult in household 
  Additional adults occupation    Business Phone    

             Rent   Own   Apartment   House   Mobile Home   Condo  
            Other (please explain)    
  Landlords Name    Landlords Phone Number    
  How many adults in your household    Children    Age of children    
  Are any members of your household allergic to animals?    
  Do you have a securely fenced yard?    Fence Height feet   
  If no fence, are you willing to:   Install a fence?    Install a pen?    
                                                     Install a run?    Leash walk? 


  List pets that you own, or have owned, in the past 5 years:
                                                                                      Spayed or
  Type of animal             Name           Age         Sex        Neutered     Still own (if not please explain)

  If you currently own a dog(s), are they on a heartworm preventative? 


  Name of Veterinarian    Clinic or Hospital   
                            City    State    Phone Number 


  Reference Name #1   Phone Number 
  Address   City   State   Zip   

  Reference Name #2   Phone Number   
  Address   City   State   Zip   


  Is there a particular F.A.C.E.S. dog that you are interested in?   
  OTHER PREFERENCES: type or breed    Age   
  Size or Weight    Characteristics 

  If adopting a puppy
  where will the puppy primarily be kept?   
  When fully grown, where will the dog be kept during the day?   
  Where will the dog sleep at night?   
  How many hours a day will the dog be without human companionship   
  and where will the dog be kept during this time
  Do you understand why we require that our adopted dogs be spayed or neutered?   
  How much would you estimate expenses to be for 1 year? Supplies $   Vet $   
  Who is the dog for:  Self   Family   Child   Gift   
  What is the purpose for the dog?  Companion   Companion for another pet  
                                                       Watchdog                                 Hunting  
                                              Other (explain) 

  Please explain why you want to adopt a dog?

  Do you have any questions or concerns?

  How did you hear about F.A.C.E.S.? 

The following will be discussed when you are contacted:
»Adoption Donation      »Adjustment to new home      »Crate Training      
»Housebreaking      »Excercise      »Feeding      »Expenses      »Obedience Classes
»Health / Veterinary Care      »Identification      »Leashing / Licensing
      »Behavior problems (excessive barking, chewing, fence jumping, digging,etc.)

The day you take home your new pet is the day you begin a very special friendship. While you'll have many years together your companionship will never outgrow his/her need for you. We will happily provide information and advice to you on pet care and responsibility.

by clicking on the submit button below you certify that the information you have given is true and you recognize that any misrepresentation of facts may result in your losing the privlidge to adopt. You understand that F.A.C.E.S. reserves the right to deny your request for adoption and you authorize the release of information from persons or agencies mentioned or listed on this application.

If you would rather mail this completed application, enter the information, print it from your broser and mail it to us at: FACES Inc,PO Box 704, W. Spfld MA, 01090