S.A.F.E. Adoption Application

		S.A.F.E. Society of Florida
S.A.F.E. Adoption Application			""

S.A.F.E. Society of Florida - S.A.F.E. Adoption Application

This form is to allow you to submit an adoption Application to the S.A.F.E. Staff for review and approval. Please be sure that ALL fields are filled out or your Application will NOT be processed.

Personal Site Information
Username	Unregistered	Group	1	User ID	0
Your Listed E-mail (Be sure this is correct or your form will not be processed)

Personal Information
First Name	Last Name
Street Address	City
State	Zip Code
Telephone	E-Mail Address
Employer
Number of Children in House	Age of Children
Are you a Home Owner or Renter?	Owner	Renter
Landlord Name	Landlord Phone
Is your Property Fenced?	Yes	No
Type Of Fence?	Height of Fence?
Reference	Reference Phone
Reference	Reference Phone
Reference	Reference Phone

Veterinarian and Pet Information
Veterinarian Name		Veterinarian Phone
Street Address		City
State		Zip Code
Name of Pet You'd Like to Adopt?		Type of Breed You'd Like to Adopt?
Age of Pet You'd Like to Adopt?		Sex of Pet You'd Like to Adopt?	Male	Female
Type of Pet You'd Like to Adopt?	Dog	Cat	Ferret	Other

General Information
How long have you been looking for a pet?
Have you done and breed Research?			Yes	No
Do you currently own any Pets?			Yes	No
Are your current Pets Spayed or Neutered?			Yes	No
Are you current Pets Protected for Heartworm?	Yes	No	Type Of Protection?
Are you current Pets Protected for Fleas and Ticks?	Yes	No	Type of Protection?
Are you prepared to make a long term commitment to this Pet?			Yes	No
If this Pet Requires training for adoption are you willing to provide it?			Yes	No
Will this Pet be Crated?			Yes	No
Are you aware of any and all medical requirments for this pet?			Yes	No

Signatures "Typing in your Name and Date here and submitting this form will server as an electronic signature"
SAFE Rep Signature		Date
Adoptor's Signature		Date

After clicking the"Submit" button you will be redirected to S.A.F.E's Home page. This will indicate that your request for an Appeal has been processed for attention. Thank you...

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