Adoption Application

What is the name of the pet that you would like to adopt?

If unsure, what are you looking for? (Personality, color, breed, sex, age)

Do you have a preference on location for adoption?

New Smyrna Beach/Port Orange
Cocoa
Doesn't matter
Not sure

Furry Nation Salvation has TWO main locations for adoptions. We always post the location of the animal with any social media posts or ads you may see.

Adopter's Name *

First

Last

Co- Adopter's Name *

First

Last

If you are a single adopter please put your name in both sections.

Adopter's phone number *

Co-Adopter's phone number

If single adopter, please put a secondary phone number (and name) of a family member or close friend.

How old are you? *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you own or rent? *

Own
Rent
Live with parents

Is the house in your name or someone else's?

We do verify home ownership

If you rent, what is your landlord’s name AND phone number?

How long have you lived in your current home?

Employment Status

Place of Employment

if you do not have a place of employment please put your co-adopter's information if available.

Work Phone Number

How long have you worked here?

Email Address *

Facebook Name

Instagram Name

Current Dwelling

When did you decide you wanted to adopt an animal?

What are the names of the adults that live in your home? *

What are the ages of the children living in your home?

How many pets currently live in your home now?

Are all of your animals spayed/neutered?

Please list the pet breed and age of your current pets

Example: 3 pets: Lab-7 years old, Tabby cat 4 years, Guinea Pig 2

What happended to your last pet if you currently don't have any?

Do you have a dog or cat door in your home?

Have you ever had to give your pet away? If yes, please explain.

Where do your current pets reside?

Inside
Outside
Both (inside and outside)
With someone else

Are you looking for an indoor cat or indoor/outdoor?

What would cause you to return a pet? Please check ALL that applies *

Current Veterinarian's name

Veterinarian's Phone Number

Are you aware that animals can live 20 years or longer depending on the type and breed?

Are you willing to allow a representative of FNS to visit your home? *

Anything else you would like to mention or want us to know to help match you with a furry friend??