FACES, 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.
APPLICANT INFORMATION
Name
Email
Address
City
State
Zip
Home Phone
Your Occupation
Business Phone
Name of additional responsible adult in household
Additional adults occupation
Business Phone
HOUSEHOLD INFORMATION
Rent
Own
Apartment
House
Mobile Home
Condo
Other (please explain)
Landlords Name
Landlords Phone Number
How many adults in your household
1
2
3
4
5
Children
0
1
2
3
4
5
Age of children
Are any members of your household allergic to animals?
-
Yes
No
Do you have a
securely
fenced yard?
-
No
Yes
Fence Height
feet
If no fence, are you willing to: Install a fence?
Install a pen?
Install a run?
Leash walk?
OTHER PETS
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)
-
M
F
-
Yes
No
-
M
F
-
Yes
No
-
M
F
-
Yes
No
-
M
F
-
Yes
No
If you currently own a dog(s), are they on a heartworm preventative?
-
No
Yes
VETERINARIAN INFORMATION
Name of Veterinarian
Clinic or Hospital
City
State
Phone Number
PERSONAL REFERENCES
Reference Name #1
Phone Number
Address
City
State
Zip
Reference Name #2
Phone Number
Address
City
State
Zip
GENERAL QUESTIONS
Is there a particular F.A.C.E.S. dog that you are interested in?
OTHER PREFERENCES:
type or breed
Age
-
Any Age
0-1yr
1-2yrs
2-3yrs
3-4yrs
4-5yrs
5+yrs
Size or Weight
Characteristics
PLEASE BE SPECIFIC WHEN ANSWERING THE FOLLOWING QUESTIONS
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
0-2hr
2-4hrs
4-6hrs
6-8hrs
8-10hrs
10 +hrs
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