Florence Area Humane Society Adoption Applicaton

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Note: This is for the FAHS in Oregon.
Click here for the FAHS in South Carolina .

Please take a few minutes to fill out the application below (either before or after you print it) and mail it to us at FAHS; 2840 Rhododendron Dr.; Florence, OR 97439 .

If you do not have a printer, then you can fill out the application below, go to the end of the form and click on the "No Printer" button. This will email the information to a volunteer who can print it and take it to the shelter. The form will not be emailed if you leave blank any of the items marked with an asteristk.

Dog Cat Other
Specific Animal(s)?

*Your Name(s)
*Home Address
*Mailing Address
*City State Zip
*Phone Number(s)
*email
Employer
Own Home Renter RV'r Other

Each animal has its own unique personality, each adoption has its own special circumstances, and you are making a commitment to care for an animal whose welfare we have been charged with. Please take a moment to answer the following questions as completely as possible. If you need help or have questions, please ask.

Why are you adopting from an animal shelter?

How many people live at your home? Ages of Children (include frequent grandchildren)

How many pets do you currently own? Dogs Cats Other

Do all members of the household know you are getting this animal? Yes No

Do any members of your household have pet allergies? Yes No
Animal phobias? Yes No

Who will care for this animal if you travel?

Are you in favor of spaying or neutering this animal? Yes No
Reason

My new pet will be Companion Animal Gift Mouse/Ratter Jogging Partner Family Pet Breeder Guard Dog Inside Outside
If animal will be outside, please describe available shelter

Will this pet be litter box trained Yes No
Litter Box location

Are you in favor of de-clawing and dew-claw removal? Yes No (Note: De-clawed cats must be indoor cats only )

What will you do if this animal becomes a nuisance, experiences behavior problems, or you are no longer able to provide for it?

Have you ever surrendered a pet to an animal shelter? Yes No
Reason

Would you object to a follow-up contact or a humane society representative making a home visitation to inspect the conditions under which this animal will live? Yes, I object No, I have no objection

Any Comments you wish to add:

I do hereby state that the above information is accurate to the best of my knowledge. I understand that knowingly providing falsified or misleading information may be considered grounds for repossession of this animal and/or prosecution. This application form is the property of the Florence Area Humane Society and may not be removed without permission of FAHS management. All information will be considered confidential. We reserve the right to refuse service to anyone.

Printed Name	Signature	Date

Please print, sign and mail this form to Florence Area Humane Society, 2840 Rhododendron Dr., Florence, OR 97439 . If you have no printer, you can click on the appropriate button to have your answers emailed to a volunteer who can print and take it to the shelter. You will be asked to sign later.

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