Faxon Animal Care & Adoption Center – Adoption Questionnaire

We sincerely hope we can be of service to you. We ask that you fill out your application completely and truthfully. This application is designed to help us determine if the adoption is in the animal’s best interest, and to assist you, the potential adopter in finding an animal most compatible with your lifestyle. An unwise adoption can result in an unpleasant experience for the adoptive family and may cause the pet to become unsuitable for any further adoptions. We hope you will agree that the animal’s welfare must be our foremost consideration. Thank you

In order to be considered for an adoption you must:
Be 21 years of age or older YesNo
Have the knowledge and consent of all adults living in your household YesNo
All members of the family must meet the chosen pet YesNo
Have verifiable identification. YesNo
Have written landlord’s consent to bring an animal onto the property YesNo
Understand that the Faxon Animal Care & Adoption Center has the right to deny your application YesNo

Your information will not be shared with anyone else.











1. Do you own your home? YesNo
Where do you live? (Please check one) Single HomeApartmentMobile HomeCondoOther
Which floor ____ Other______________

2. If renting: Name, Address and Phone# of Landlord:

3. How long have you lived at this address? Do you plan to move in the next six months? YesNo

4. Number and ages of any children in the home

5. Are you interested in adopting a pet for: YourselfMember of FamilySomeone Else

6. Is this your first experience with a pet? YesNo

7. Do you or does anyone living in your household have any known allergies to animals? YesNo
If yes, to what kind(s) of animals and how severe is the allergy?

8. Are you familiar with local animal control laws? YesNo

9. Yearly veterinary and daily care for a pet can cost as much as $800.00 or more annually. Are you prepared to spend this amount on your new pet? YesNo

10. Who will be responsible for paying for this care?

11. Please list all pets that you have been responsible for within the last five years…
Past Pet(s), Name and Species

Current Pet(s), Name and Species

12. List the names of all veterinarians and/or clinics your pets have visited while in your care. (Please be complete in listing every vet or medical facility your pet has visited. This is very important.)

13. Please check any of the following reasons for wishing to adopt:
A. Dog: BreedingGuard/WatchdogCompanionFamily PetHuntOther
If other, please explain:

B. Cat: BreedingMouserCompanionFamily PetOther
If other, please explain:

14. Where will this pet be kept during the day? At night?

15. How many hours will this pet spend alone without human companionship?

16. Where will it be kept when alone?

17. Do you have a fenced yard? YesNo

18. Cats and dogs can live longer than 15 years. Are you ready to take responsibility for the pet’s entire life? YesNo

19. Have you adopted a pet from us before? YesNo
If yes, when? Do you still have this pet? YesNo If no, Where is it now?

20. Have you ever brought an animal into a shelter? YesNo If yes, why?

How long ago was this and to what shelter was it brought?

21. Since many shelter animals have unknown medical backgrounds, are you prepared to provide and pay for any necessary medical treatment your new pet may require after adoption? YesNo

HOW DID YOU HEAR ABOUT US?

I understand the above questions and I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for denial of adoption.