Dog Adoption Application

Hidden
Default: Adopter Status
First Name*
Last Name*
Age Range*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
ZIP*
Country
Home Phone Number
Work Phone Number
Cell Phone Number*
- Preferred Method of Contact*
Employment & Schooling
- Are You Employed?*
  - Yes
  - No
  - Retired
- Full or Part Time?*
- Name of Employer or Job Title
- Are You in School?*
  - Yes
  - No
- Full or Part Time?*
- How Did You Hear About Us?*
- What Is Your Friend's Name?
- Which Shelter?
- Which Rescue?
- Please Describe

Below are three areas for information on other members of your family. Please include all other adults, children and pets living in your home by clicking on the designated button.
Are There Other Adults In The Home?*
- Yes
- No

Add Adults

First Name	Last Name	Age Range	Actions

There are no Adults.

Add Children

Age	Previous Experience with Dogs:	Actions

There are no Children.

Do You Now or Have You Ever Had a Dog?*
- Yes
- No
Have you ever taken care of a dog before (ie dog walker, dog sitter, etc) or have any other dog experience?*
Please Describe*

Add Dogs

Dog's Name	Breed	Age Range	How Long Did You Own Him/Her?	Actions

There are no Dogs.

Add Pets

Pet's Name	Animal Type	Sleeping Quarters	Actions

There are no Pets.

Would You Consider:
Select Gender*
Select Age Range*
Select All That Apply
Select Personality*
Select All That Apply
Do You Have A Preferred Dog?
Note: This does not guarantee this dog will be placed with you
List Other Dogs You Are Interested In
When Will You Be Ready To Adopt?*
Is There Anything Else You Would Like to Let Us Know?
I am interested in receiving pet related services and products*
- Yes
- No
Authorization
Authorization:*
All dogs placed through Final Victory Animal Rescue will have health checks, personality and temperament evaluations, and will be spayed or neutered prior to placement unless a medical condition exists, diagnosed by a veterinarian, that would prevent this surgery. I understand that this is a preliminary application and that there may be no Dog available in rescue at this time. I understand that if a Dog should become available, that I will be required to provide further information including, but not limited to, personal and veterinary references. I further understand that all information on my Preliminary Rescue Adoption Application will be kept confidential; that my application will be kept on file until I notify Final Victory Animal Rescue that I am no longer interested in a rescue; and that I will not be contacted unless an appropriate Dog becomes available. I understand and agree *
- I agree
Name
This field is for validation purposes and should be left unchanged.

Employment & Schooling