Name of Animal you wish to Adopt:
     
1. Adopters Information
     
*Adopters Name:
 
*Address:
 
*City:
*State
*Zip:
 

*Home Phone:
   
Alternate Phone:
   
Best Time to Call:
   
* Email:
Adopters Occupation:
Spouse/Roommate#1:
Occupation#1:
 
Spouse/Roommate#2:
 
Occupation#2:
   

 

   
2. Personal Reference(s)
     
Name1:
Phone:
 
Relationship:
How long have you known the reference?
    Years Months
         
 
3. Residential Information
     
Do you own or Rent you Home? Rent Own  
If you rent, do you have you landlord's permission to keep a dog? Yes No
Landlord's Name :
Phone:

Do you live in
(Please Select One of the following)

House
Trailer  
Apartment
Condo  
  Dorm Room
Other  
How Long Have you lived at the address? Years Months  
       
Do You have a Fenced Yard?
Yes No Fence Height Ft. Fence Type:
Does fencing completely enclose the yard for dog? Yes No  
If No, how will you handle dog's exercise and toilet needs?  
Do you have a separate kennel run? Yes No
If Yes , please list the height and size : Length Width Height
 
4. Family Information
 
How Many adults in household?
 
How Many children in household?  
Child#1
Age
Sex: Male Female
Child#2
Age
Sex: Male Female
Child#3
Age
Sex: Male Female
Child#4
Age
Sex: Male Female
Child#5
Age
Sex: Male Female
         
Are there regular visitors to your home, human or animal, with which your new dog must get along?
Yes No  
   
If Yes, please describe:  


5. Pet Information
 
Do you own other Dogs ? Yes No
If Yes, please provide breed, sex and age of each.  
Dog#1 Breed
Sex
Male Female Age
Fixed
Yes No
Dog#2 Breed
Sex
Male Female Age
Fixed
Yes No
Dog#3 Breed
Sex
Male Female Age
Fixed
Yes No
Dog#4 Breed
Sex
Male Female Age
Fixed
Yes No
Dog#5 Breed
Sex
Male Female Age
Fixed
Yes No
Do you Own Cats? Yes No    
If Yes, How Many?    
Are they spayed /neutered? Yes No    
Do you own any other animals? Yes No    
If Yes, How Many do you Own?    
What are they?
Birds Fish Reptile
Cattle Goats Sheep
Chickens Horses Spiders
Ducks Llamas Turkeys
Donkey/Mule Rodent Other
Ferret Pigs Other
             
6. Veterinary Information
     
Do you have a regular Veterinarian? Yes No  
If Yes, Please give name:  
Veterinarian's City
Phone:
May we contact your Vet for a reference? Yes No  
Additional Comments?  
       
7. Historical Information
       
* How many dogs or cats have you owned in the last five years that you no longer have?
* If applicable, what happened to these pets? (please be specific).  
 
8.Reason for Adopting Dog
       
List all the plans for this dog (You may check more than one box)
Pet Guard Hunting Agility Obedience Other:
             
9. Caring for the Dog
 
Where will the dog spend the day?
Loose Indoors Crate Basement Fenced Yard   Loose Outdoors
Tied up Outdoors Kennel/Run Garage Other:
How many hours, on average will dog spend alone? Hours
Where Will the dog speng the night?
Loose Indoors Crate Basement Fenced Yard Loose Outdoors
Tied up Outdoors Kennel/Run Garage Other:

What brand or type of food do you plan to feed your new friend?

What behaviors would you consider a problem and how would you handle it?
Please Explain
         
110. General Information
Are there any family members allergic to dogs? Yes No
If Yes, Please Explain
Do all family members want to adopt a dog? Yes No
If No Please Explain  
 
11. KCFOA Disclosure
   
* Do you understand KCFOA Requires all adopted dogs to be spayed or neutered ? Yes No
* Do you agree to license an adopted dog and give regular health care? Yes No
* Do you agree to contact KCFOA if you can no longer keep this dog? Yes No
* Would you be willing to let a representative of KCFOA visit your home by appointment? Yes No
If No, Please Explain:  
 
   

Note: The home visit is typically done when we deliver the pet to its new home and the visit serves two purposes:

  1. It helps the foster person with closure about the placement of the pet.
  2. It allows us to make sure our fosters are being adopted by the person who filled out the application, and not by hoarders or bunchers (people who sell animals for use in experiments.)
   
12. How Did You Hear About Us?
Internet Sereach Referral Veterinarian
PetFinder.Com Word of Mouth Flyer
Newspaper Article Magazine Article Other
           
13. KCFOA Terms of Adoption
 
1. Any pets that have been adopted through KCFOA must be returned to KCFOA if a home can no longer be provided.
2. Medical care and regular vaccines must be provided to the adopted pet.
3. Food and shelter must be provided.
4. If the pet is not being cared for as required, or being abused, KCFOA has the right to take the pet back into it's care.
 
 
By checking the Agree button below you are agreeing that:
All of the information I have given above is true and complete to the best of my knowledge. I have also read and agree with KCFOA's Terms of Adoption. This dog will reside in my home as a pet. I will provide it with adequate food, water, shelter, training, affection and medical care. I am in full agreement with these terms of adoption. Kittitas County Friends of Animals is in no way liable or responsible for any damage, accident, or injury resulting from the placement of the dog into my household.
 
Agree *
 
Please note: * Designates a Required Field