Animal Friends of Barbour County

Adoption Application

Name_________________________________________________________   Date_____________________

Street Address____________________________________________   City___________________________

State__________     Zipcode_____________     E-Mail Address____________________________________

Home Phone________________ Work Phone___________________ Cell Phone______________________

Why do you want to adopt a pet?_____________________________________________________________

________________________________________________________________________________________

What do you consider to be the most important responsibilities in owning a pet?______________________

________________________________________________________________________________________

For whom are you adopting this pet?  Myself______     My Family_____  Relative/Friend_____

If other than yourself or your family, is the person you plan to give this pet to aware of your decision to give

this pet to them?  Yes_____     No_____

If disciplinary or behavioral problems arise with your new pet, what steps will you take to resolve them?

________________________________________________________________________________________

________________________________________________________________________________________

Do you or any members of your family have any allergies to animals?  Yes_____     No_____   If yes, please

explain. _________________________________________________________________________________

________________________________________________________________________________________

Do other pets currently live in your home:  Yes_____     No_____          If yes, please list what kind and how

many?___________________________________________________________________________________

_________________________________________________________________________________________

If you currently have pets, are vaccinations up-to-date?  Yes_____    No_____

Do you have current licenses for dogs you now own?  Yes_____  No_____

Have you previously owned pets?  Yes____   No_____              

If yes, please list what kind and how many. ____________________________________________________

________________________________________________________________________________________

Do you usually have your pets spayed/neutered?  Yes_____     No_____

Please provide us with a veterinary reference.

Vets Name________________________________________   Phone Number_________________________

Are there children in your household?  Yes_____     No_____  If yes, please list their ages._____________

_______________________________________________________________________________________

Do you rent or own your residence?  Rent_____     Own_____  If you rent your residence, have you already

obtained your landlord's permission to have this pet in your home?  Yes_____     No_____

Do you have a fenced yard?  Yes_____     No_____

Where will this pet primarily be kept?  Primarily indoors_____     Primarily outdoors_____

I will agree to have my adopted pet spayed/neutered.  Yes_____     No_____

I have read the above information carefully and have filled out this application honestly.  I understand that omission of information and/or failure to answer all the questions can result in the application being declined.  Also, if an omission or untruth is discovered after the adoption takes place, I understand that Animal Friends of Barbour County reserves the right to annul the adoption 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 and yard visit on a mutually agreed upon date by a representative of Animal Friends of Barbour County, if requested.

Signature_______________________________________________

Please mail completed applications to:

AFBC

c/o C. Skrodinsky

HC-31 Box 290

Volga  WV  26238