Street Address
Zip Code
Primary Phone Number
Alternate Phone Number
Email Address
How many children live in your household?
What is the age of each child?
What is your age:
Are you currently:
What is the name of the shelter pet you would like to adopt?
Is this pet a cat or dog?
What is the pet's breed:
For whom are you adopting this pet?
If other than yourself or your family, is the person you plan to give this pet to aware of your decision to give the pet to them?
If disciplinary or behavioral problems arise with your adopted pet,
what steps will you take to resolve them?
Do you or any members of your household have any allergies to animals?
If yes, please list what kind and how many.
Do you currently have pets?
If yes, please list what kind and how many.
If you currently have a pet(s), are vaccinations up-to-date?
Do you have current licenses for dogs you now own?
Do you usually have your pets spayed or neutered?
Please give us a veterinary reference.  Include the name of your vet, the vet office phone number and the name of your pet that's been treated at that office.
Do you own or rent your residence?
If you rent, have you obtained your landlord's permission to have a pet in your home?
Do you have a fenced yard?
Where will this pet be kept?
I understand and agree that a pet adopted from Animal Friends must be spayed or neutered.
I understand and agree to the following Terms and Conditions.
I have read the above information carefully and have filled out this application honestly. I understand that omission and/or failure to truthfully answer the questions can result in the application being declined.  Also, if an omission or untruth is doscovered after the adoption takes place, I understand that Animal Friends of Barbour County reserves the right to annul this Adoption Contract and reclaim the animal.  I give Animal Friends of Barbour County permission to fully investigate the information I have provided, as well as contact the veterinarian I listed.  If this application passes review, I would agree to a home visit on a mutually agreed upon date by a representative of Animal Friends of Barbour County, if requested. 
You may use this textbox if you have any questions, need to request more information or have additional comments.  Please be brief.
Thank you for taking the time to complete this application for adoption.  We appreciate your interest in adopting a shelter pet and will contact you as soon as possible after we receive this completed form.  IMPORTANT NOTE!  Do not complete and submit this application using a cell phone.  It WILL NOT reach us.
If this application is for a CAT, please click the button below.
If this application is for a DOG, please click the button below.
If employed, please provide employer's name.
Oreo, now known as Reggie, is doing great! We know why he was surrendered. Big....time chewer, nothing is safe. He is a very happy dog. Loves sleeping on sofa with my husband. Gets along with the cat. Loves the neighborhood dogs. We went on trip, he is a perfect car rider. In that one photo, he was barking at the frog. Big bad dog. Hair is still growing. Who knows how it will finish. He is getting fat. He’s a chow hound. We will have to watch his weight. 

We thank you for doing all you do. Tell the other girls at shelter. 

Under 1818 or older
MyselfMy FamilyFriend/Relative
I Agree
I Agree