ANIMAL ADOPTION REQUEST

After you print and complete this form, you may fax it to 662-841-5871 or mail it to:

Compassion First
PO Box 2401
Tupelo, MS 38803

Date:_____/_____/________

Name:__________________________________________________________________

Address:________________________________________________________________

Telephone (include area code) (H)_____________________(W)____________________

Directions to the address where the animal will live:

_________________________________________________________________________

_________________________________________________________________________

What animal are you interested in adopting?______________________________________

Please check the reason you want to adopt an animal:

___ Companion

___ Guard Dog

___ Gift

___ To Breed

___ Personal Protection

___ For Child

___ Other (Please describe):______________________________________

Is someone home during the day?__________During what hours?_______________

Who will be responsible for this animal?__________________________________

Who will be responsible for housebreaking an untrained animal?____________________

Do you own your own home?________Rent?________Live with parents?__________

Is your residence a house?______Townhouse?______Apartment?__________

If renting, landlord's name and phone number:__________________________________

How many children live in your home?________  List ages_______________________

Does any member of your family have allergies to animals?_______________________

When you go on vacation, who will care for your dog?____________________________

Do you anticipate moving soon?____________________

Are you military?_____________

If you move, what will you do with your animal?________________________________

What types of pets have you owned in the last five years?

Type of animal     Sex(M/F)  Age   Neutered(Y/N)   What happened to it?

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

_____________________________________________________________________________

Do you have a veterinarian now?________Vet's name___________________________

How much do you think it will cost to take care of this animal each year?
(Consider the cost of veterinary care, food, grooming, licensing, etc)

_____________________________________________________________________________

Have you adopted from us before?_________________________________________________

Do you have a fenced-in yard?_______ Fence height____________Type__________________

Where will the dog sleep?___________ and stay when away during the day?________________

How will the dog be confined when outdoors?_________________________________________

We require that all dogs adopted be spayed or neutered. Do you have any questions or reservations about this?_____________________________________________________

Do you understand that all animals will require a series of vaccinations and that adults will need an annual vaccinations, including rabies?__________________ 

Signature____________________________________

Rev. 03/03