Please, copy and paste this form into a new email, complete all the questions, and send to: ndars1@yahoo.com.  If you prefer, print, complete, and either “snail mail” it or fax to Karen Wingo, AFAR, 8507 US Highway 278 E, Hokes Bluff, AL  35903. (256-492-1366….please call this number prior to fax, and let us know it’s coming)

Thanks for your interest in Adoption.  This is an important decision, and should never be taken
lightly.  If, after discussion with your family, you feel ready to bring one of our babies into your hearts and homes, then complete this application and click on send at the bottom.

You MUST be at least 21 years of age to apply.  If you are under this age, you will need to have
someone willing to co-adopt with you.  This is to ensure the safety of all of our adoptables, not to
discriminate in any way.  We apologize for any inconvenience this may cause, but our babies mean
the world to us, so what can we say?

We MUST have at least 3 references, one of which MUST be a veterinarian.  If you cannot provide
this information, please do not apply.  By applying, you are agreeing to a reference check, a home
visit prior to placement, and if approved, a minimum of 2 post-placement visits as well.  This is so that
we can see the environment the animal will live in, and to ensure that your new baby is adjusting well.

Name of Applicant: ___________________________________________________________

Home Address (and Mailing address, if different): ___________________________________

___________________________________________________________________________

___________________________________________________________________________

Spouse’s Name (if joint application): ______________________________________________

Age of Applicant(s): ___________________________________________________________

Home Phone: __________________________________   Best time to call: ______________

Work Address (if retired, please note): ____________________________________________

____________________________________________________________________________

____________________________________________________________________________

Work Phone: __________________________________   Best time to call: _______________

Email Address/Fax Number: _____________________________________________________

Number of Household Members (do not include yourself and spouse): _____________________

Please list Members Names, Ages, and indicate whether they have been around animals prior to

this application: _______________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

References (please list your current Veterinarian first…if you do not presently have a veterinarian, please list the name and phone number of the vet you are planning on using):

Name: __________________________________________________________________________

Address: ________________________________________________________________________

Phone Number: ___________________________________ Hours of Operation: _______________

Name: __________________________________________________________________________

Address: ________________________________________________________________________

Phone Number: _______________________________  Best time to call: ____________________

Name: __________________________________________________________________________

Address: ________________________________________________________________________

Phone Number: _______________________________  Best time to call: ____________________

Number of Pets currently in Household: ________________________________________________

Are all currently owned pets UTD on all vaccinations? _____________________________________

Are all currently owned pets spayed/neutered? __________________________________________

Please list all currently owned pets (indicate what breed, sex, ages, and temperaments): _________

_______________________________________________________________________________
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_______________________________________________________________________________

Animal applying for: _______________________________________________________________

Please answer the following questions to the best of your ability (please give details…use extra paper if needed):

1) Have you ever owned a companion animal before?

2) If so, what type was it?

3) If so, where is that animal now?

4) If given away, to whom and why?

5) Would you be willing to accept a different animal than you are applying for?

6) If not, why?

7) Are you familiar with the special needs of some breeds?

8) If not, are you willing to learn more, either from us, or from a professional?

9) Is everyone in your family in agreement with getting a companion animal?

10) If not, how will you resolve this issue?

11) Do you rent or own your home?

12) If renting, please give landlord’s name, address, and phone number:

13) How long have you resided at this address?

14) Do you have any plans to move within the next year?

15) Do you have a fenced in yard or other enclosure for the animal to exercise in?

16) If so, please describe area (type of fence, height, etc):

17) Do you have a pool?

18) If so, is it securely enclosed?

19) Will the animal be left unattended outdoors or alone for long periods of time?

20) If so, why, and under what circumstances?

21) What accommodations will you make if you are away overnight or on vacation?

22) Please give name, address, and phone number of caretaker that you would use for this:

23) What part of the house will the animal primarily reside in?

24) Who will be the primary caretaker for the animal’s upkeep (grooming, feeding, walks, etc)?

25) What methods would you use to discipline your new companion?

26) Are you prepared to make a lifetime commitment to this animal?

27) Are you prepared for any accidents or messes the animal might make while adjusting to its new home (potty accidents, marking territory, etc)?

28) Are you willing to use ONLY positive reinforcement to correct any unwanted behavior the animal might show?

29) Please add any other information you feel will be helpful to us in making a determination on your application.