Before submitting, please be aware that we only accept applications from within 1 hour of Albany, NY! Adoption Application Step 1 of 10 10% Please remember that we only adopt within 1 hour of Albany, NY.Pet ownership is a long-term commitment that an entire household should be willing to participate in before agreeing to bring a pet home. This application will help you determine what type of pet you are looking for and if you are ready to properly care for a pet. It will also help match you with the best possible pet for your lifestyle. Please fill out the application accurately and entirely and do not hesitate to call with any questions.Contact InformationAre you at least 21 years old?*We only accept applications from those 21 or older!YesNoName* First Last Primary Phone Number*Secondary Phone NumberWork Phone NumberEmail* Enter Email Confirm Email Physical Address* Street Address Address Line 2 City State / ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Household InformationDo other adults reside with you?*YesNoNames of Adults living with you*Add one line per adult (use the + button to add more lines)NameRelationship Does your entire household know that you are considering adopting a pet?*YesNoWhy not?*Does anyone in your household have allergies or asthma?*YesNoDo pets/dander trigger a reaction?*YesNoDescribe your homes activity level*Busy/active/noisyModerate comings/goingsQuiet occasional guestsChildrenDo you have children?*YesNoChildren in the house*Include age and if they live there full time, one line per child.AgeDo they live there full time? Note any type of pet(s) they have shown fear of:*Do other children visit?*YesNoChildren who visit*Include age and how often they visit, one line per child.What ages are they?How often do they visit? Where did you hear about us?Have you spoken with a Volunteer here?YesNoVolunteer Name General Pet InfoWhat type of pet do you want to adopt?*DogCatWhy do you want to adopt a pet?* Companionship Breeding Protection Other What other reason(s) do you have for wanting to adopt a pet?*Is this your first pet?*YesNoWho is the pet for?*YourselfSomeone ElseWhat is your relationship to this person?*Where will the pet be primarily housed?*Where will pet sleep?*Where will your pet be when no one is at home?* Loose outside Loose inside Tied/chained outside Kennel run/fenced area outside Crated Otherwise confined inside Other What other place(s) will your pet be when no one is home?*Explain where the pet will be confined when no one is home.*Will the cat/kitten be:* Indoors Only Indoors / Outdoors Outdoors Only DogsApplications will NOT be processed without a specific name of an animal in the program. You can find more information here: Available PetsIs there a particular dog you are interested in?*Name(s)Please note your dog preferences:* Purebred Mixed Breed No Preference Breeds of interest to youMost of the time we only have small breeds.AfadorAffenpinscherAfghan HoundAiredale TerrierAkbashAkitaAlaskan Klee KaiAlaskan MalamuteAmerican BulldogAmerican English CoonhoundAmerican Eskimo DogAmerican FoxhoundAmerican Leopard HoundAmerican Pit Bull TerrierAmerican PugabullAmerican Staffordshire TerrierAmerican Water SpanielAnatolian Shepherd DogAppenzeller SennenhundeAuggieAussiedoodleAussiepomAustralian Cattle DogAustralian KelpieAustralian RetrieverAustralian ShepherdAustralian Shepherd HuskyAustralian Shepherd Lab MixAustralian TerrierAzawakhBarbetBasenjiBassadorBasset Fauve de BretagneBasset HoundBasset RetrieverBavarian Mountain Scent HoundBeabullBeagleBeaglierBearded CollieBedlington TerrierBelgian MalinoisBelgian SheepdogBelgian TervurenBerger PicardBernedoodleBernese Mountain DogBichon FriseBiewer TerrierBlack and Tan CoonhoundBlack Mouth CurBlack Russian TerrierBloodhoundBlue LacyBluetick CoonhoundBockerBoerboelBoglen TerrierBologneseBoradorBorder CollieBorder SheepdogBorder TerrierBordoodleBorzoiBoShihBossieBoston TerrierBouvier des FlandresBoxerBoxerdoodleBoxmatianBoxweilerBoykin SpanielBracco ItalianoBraque du BourbonnaisBriardBrittanyBroholmerBrussels GriffonBuggBull TerrierBullboxer PitBulldogBullmastiffBullmatianCairn TerrierCanaan DogCane CorsoCardigan Welsh CorgiCatahoula BulldogCatahoula Leopard DogCaucasian Shepherd DogCavachonCavadorCav-a-JackCavalier King Charles SpanielCavapooCesky TerrierChabradorCheagleChesapeake Bay RetrieverChihuahuaChilierChinese CrestedChinese Shar-PeiChinookChipinChi-PooChiweenieChow ChowChugChuskyCirneco dell’EtnaClumber SpanielCockalierCockapooCocker SpanielCollieCorgi InuCorgidorCorman ShepherdCoton de TulearCurly-Coated RetrieverDachsadorDachshundDalmatianDandie Dinmont TerrierDaniffDeutscher WachtelhundDoberdorDoberman PinscherDockerDogo ArgentinoDogue de BordeauxDorgiDoxiepooDoxleDrentsche PatrijshondDreverDutch ShepherdEnglish Cocker SpanielEnglish FoxhoundEnglish SetterEnglish Springer SpanielEnglish Toy SpanielEntlebucher Mountain DogEstrela Mountain DogEurasierField SpanielFinnish LapphundFinnish SpitzFlat-Coated RetrieverFox TerrierFrench BulldogFrench SpanielGerman PinscherGerman Shepherd DogGerman ShepradorGerman Shorthaired PointerGerman SpitzGerman Wirehaired PointerGiant SchnauzerGlen of Imaal TerrierGoberianGoldadorGolden Cocker RetrieverGolden Mountain DogGolden RetrieverGolden ShepherdGoldendoodleGollieGordon SetterGreat DaneGreat PyreneesGreater Swiss Mountain DogGreyhoundHamiltonstovareHanoverian ScenthoundHarrierHavaneseHokkaidoHorgiHuskitaHuskydoodleIbizan HoundIcelandic SheepdogIrish Red and White SetterIrish SetterIrish TerrierIrish Water SpanielIrish WolfhoundItalian GreyhoundJack ChiJack Russell TerrierJapanese ChinJapanese SpitzKarelian Bear DogKeeshondKerry Blue TerrierKomondorKooikerhondjeKorean Jindo DogKuvaszKyi-LeoLab PointerLaberneseLabmaranerLabrabullLabradaneLabradoodleLabrador RetrieverLabrastaffLabskyLagotto RomagnoloLakeland TerrierLancashire HeelerLeonbergerLhasa ApsoLowchenMalteseMaltese Shih TzuMaltipooManchester TerrierMastadorMastiffMiniature PinscherMiniature SchnauzerMixMorkieMudiMuttNeapolitan MastiffNewfoundlandNorfolk TerrierNorwegian BuhundNorwegian ElkhoundNorwegian LundehundNorwich TerrierNova Scotia Duck Tolling RetrieverOld English SheepdogOtherOtterhoundPapillonPeekapooPekingesePembroke Welsh CorgiPetit Basset Griffon VendeenPharaoh HoundPitskyPlottPocket BeaglePointerPolish Lowland SheepdogPomapooPomchiPomeaglePomeranianPomskyPoochonPoodlePortuguese Podengo PequenoPortuguese Water DogPugPugalierPugglePuliPyrenean ShepherdRat TerrierRedbone CoonhoundRhodesian RidgebackRottadorRottweilerSaint BerdoodleSaint BernardSalukiSamoyedSamuskySchipperkeSchnoodleScottish DeerhoundScottish TerrierSealyham TerrierShepskyShetland SheepdogShiba InuShih TzuShih-PooShiranianShollieShorkieSiberian HuskySilken WindhoundSilky TerrierSkye TerrierSloughiSmall Munsterlander PointerSoft Coated Wheaten TerrierSpringadorStabyhounStaffordshire Bull TerrierStandard SchnauzerSussex SpanielSwedish VallhundTibetan MastiffTibetan SpanielTibetan TerrierToy Fox TerrierTreeing Tennessee BrindleTreeing Walker CoonhoundValley BulldogVizslaWeimaranerWelsh Springer SpanielWelsh TerrierWest Highland White TerrierWestiepooWhippetWhoodleWirehaired Pointing GriffonXoloitzcuintliYorkipooYorkshire TerrierWhat other breed are you interested in?Male or Female*MaleFemaleNo PreferenceAge Range* Puppy Young Adult Senior No preference Hair Type* Hypoallergenic Short Hair Long Hair No Preference Would you consider A special needs dog Adopting two dogs A senior dog Size* Mini (up to 10 lbs) Small (10-30 lbs) Medium (30-45 lbs) Large (50-75 lbs) Giant (75 lbs and up) No Preference Is there a leash law in your town?*YesNoWould the dog be off leash?*YesNoUnder what circumstances will they be off leash?*How will your dog be exercised?* Off leash in an unfenced area Off leash in a fenced area Walked on leash Dog park Other Other*What other way will your dog be exercised?Do you have a doggy door?*YesNoPlease explain when the doggy door would be locked vs unlocked?*Would the dog be left outside unsupervised?*YesNoHow long would the dog be left outside unsupervised?*When left out alone for this period what type of shelter is available?* Shade tree Covered Area Shed None Other Other*What other type of shelter is available?What problems or situations would make you return a dog?* Nothing Excessive Barking Housebreaking Jumping up Shyness/other fears Shedding Digging Pet’s activity level Scratching/Climbing on furniture Moving New Baby Personal illness Divorce Chewing Cost of Pet Care Other Other*What other problem or situation would make you return a dog?To help resolve some problems are you willing to: Use a crate Enroll in obedience classes Other Other*What else would you be willing to do to resolve some problem?Do you feel a dog should be spayed or neutered?*YesNoWhy not?*Approximately how many hours would the dog be left alone on an average day?*WeekdaysWeekendsHow would you discipline a dog that chewed or destroyed your personal belongings?*Who will be responsible for daily pet care?*Caregiver when primary person is away?*If you adopt a dog from us, will you:* Dock Tail Dock Ears Debark Other None of the above Other* CatsIs there a particular cat you are interested in?*Name(s)Please note your cat preferences* Short Hair Long Hair No preference Male or Female?*MaleFemaleNo PreferenceAge range* Kitten Young Senior No Preference ColorWould you consider: A special needs cat Adopting 2 cats A senior cat What problem or situations would make you return a cat?* Nothing Meowing Housebreaking Shyness/other fears Shedding Pet’s activity level Scratching furniture Climbing on furniture Moving New Baby Personal Illness Divorce Chewing Cost of Pet Care Other Other*What other problem or situation would make you return a cat?What are you willing to do to help resolve problems?*Do you feel a cat should be spayed or neutered?*YesNoWhy not?*Approximately how many hours would the cat be left alone on an average day?*WeekdaysWeekendsHow would you correct a cat that damaged your personal belongings?*Who will be responsible for daily pet care?*ie – changing litter pan, feedingCaregiver when primary person is away?*If you adopt a cat from us, will you:* Declaw Other None of the above Other* FenceDo you have a fence?*YesNoInvisible fenceKennel runTrolley runNo outside confined areaOtherPlease describe what you have:*Material, size, height, number of entrances, if it is attached to your residence, etc.Is the fence attached to your residence?*YesNoWhat material is the fence made of?*Height of the fence:*Size of the fenced area:*Is the fence securely enclosed on all four sides?*YesNoHow many gates?*Do all of the gates securely latch and lock?*YesNoWhy do all or some of the gates not securely latch and lock?*Pool/Hot TubDo you have a pool or hot tub?*YesNoIs there a barrier to keep pet out of the pool/hot tub?*YesNoDescribe the barrier to keep the pet out:* Home Visit InformationPlease list several preferences for a home visitTimes and Day of the WeekHousing InformationDo you live in a:*HouseApartmentMobile HomeAre you the owner or renter of the residence listed?*OwnerRenterLandlord InformationYou MUST have proof that you are allowed pets on the premise from the owner.Landlord Name*Landlord Phone Number*Are there any restrictions on pet(s) weight, type, breed, etc. from the Landlord?* Pet InformationDo you currently have any pets?*YesNoPlease list pets currently owned and provide requested information:*NameTypeAgeSpayed/NeuteredName of Heartworm Preventive Used If any of your pets are not spayed or neutered, why not?*Have you previously owned pets in the past 5 years?*YesNoPlease list all pets previously owned in the past 5 years and describe what happened to them.*Not including not fish or reptiles.NameTypeWhat happened to them? ReferencesReference Name* First Last Reference Phone Number*AddressNot required Street Address Address Line 2 City State / ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Veterinarian Name*Other, enter name belowI am going to contact oneAdirondack Animal HospitalAlbany County veterinarianAmsterdam Animal HospitalAnimal Care Hospital of Clifton ParkAqueduct Animal HospitalBanfield Pet HospitalBerkshire Veterinary HospitalBethlehem Veterinary HospitalBloomingrove Veterinary HospitalBoght Veterinary ClinicBurnt Hills Veterinary HospitalCanterbury Animal HospitalCatskill Animal HospitalCentral Veterinary HospitalChathams Small Animal HospitalClifton Park Veterinary ClinicCobleskill Veterinary ClinicColonie Animal HospitalCountryside Veterinary HospitalDelmar Animal HospitalDrumm Veterinary HospitalEast Greenbush Animal HospitalGlens Falls Animal HospitalGlenville Veterinary ClinicGreenfield Animal HospitalGreylock Animal HospitalGuilderland Animal HospitalHarmony Veterinary ClinicHaven Animal HospitalHomestead Animal HospitalHowes Cave Animal HospitalKinderhook animal hospitalLatham Animal HospitalMandak Veterinary ServicesMiller Animal HospitalMilton Veterinary HospitalMountainview Animal HospitalNassau Veterinary ClinicNew Baltimore Animal HospitalOakwood Veterinary ClinicParkside Veterinary HospitalRiver Road Animal HospitalRotterdam Veterinary HospitalSand Creek Animal HospitalSandcreek Animal HospitalShaker Animal HospitalThe Animal HospitalThe Village Animal ClinicWhat is the name of the vet you are going to contact if you have decided.Veterinarian Name*Veterinarian Phone Number*Veterinarian Address Street Address Address Line 2 City State / ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code AuthorizationYour application CAN NOT be processed until YOU CALL the vet!* I agree to call my vet to release medical history to a Free To Be Me Rescue representative. Is there anything else you would like us to know?Will you permit us to share your application with other rescue groups?YesNoI am aware of any limitations on the number of animals my municipality imposes and state that I am not over those limitations.*InitialInformationIf an adopter cannot keep the pet for its lifetime, the pet MUST be returned to Free To Be Me Rescue under the conditions specified in the Animal Adoption Contract. If the pet is not yet spayed or neutered, an approved adopter may only foster the pet until the procedure is done by a veterinarian chosen by Free To Be Me Rescue (per the Unaltered Foster Care Agreement) after which the pet may be adopted, at Free To Be Me Rescue discretion. Each pet adoption is assessed a Non-refundable fee which helps pay for the medical and other expenses incurred by Free To Be Me Rescue on behalf of the pet. By signing below I acknowledge that I have completely read the Application, comprehend it fully, and know that applying does not insure approval and that my answers will be taken at face value. I also understand that Free To Be Me Rescue reserves the right to disapprove any applicant for any reason and that untruthful answers or failure to comply with the requirements of this Application, the Foster Agreement, or the Adoption Contract may result in forfeiture of any Free To Be Me Rescue pet which may be fostered and/or adopted by me.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.PhoneThis field is for validation purposes and should be left unchanged.
