New Submission

Fayetteville Animal Services Clinic
340 Armstrong Avenue
Fayetteville, AR 72701
479-444-3456

Applicant Information

Name*field type single line
Input blocked. Maximum character limit of 60 characters reached.
Date of Birth*field type date
We do not adopt to anyone under 21 years of age.
mm/dd/yyyy
Address*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Home/Cell Phone*field type single line
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Work/Other Phonefield type single line
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Email Addressfield type single line
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Driver's License Number*field type single line
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Driver's License State*field type drop-down

Home Information

Own or Rent?*field type radio button
Own or Rent?OwnRent
Landlord's Name*field type single line
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Landlord's Phone*field type single line
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What best describes your home?*field type radio button
What best describes your home?House with fenced yardHouse with unfenced yardHouse with outside kennel runMobile home/condo/apartment with fenced yardMobile home/condo/apartment without fenceFarm with livestock
Are there children in the home?*field type radio button
Are there children in the home?YesNo
Child Information
×
- Age*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
Add Additional Child
Is the pet going to be a gift?*field type radio button
Is the pet going to be a gift?YesNo
For whom?*field type single line
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Pet Information

Due to COVID-19, visitors to the Fayetteville Animal Services office are required to have an appointment and obey social distancing guidelines.
You may view pets up for adoption by following this link: Fayetteville Animal Services Adoption Search.
To adopt a pet, please complete this form and we will contact you to set up an appointment. Please note that applications are processed on a first-come, first-serve basis. Please list the name of the pet or pets you are interested in to reserve your preferred animal.
Have you visited Fayetteville Animal Services online or in person to look at pets up for adoption?*field type radio button
Have you visited Fayetteville Animal Services online or in person to look at pets up for adoption?YesNo
Important: Please visit the Fayetteville Animal Services Adoption Search page to view and select a pet up for adoption. Pets are adopted on a first-come, first-serve basis, so listing your preference will help ensure that you are able to adopt the pet or pets that you prefer.
What pet/pets are you interested in?*field type single line
Name or Animal ID Number from the Adoption Search website
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Where will you keep your pet during the day?*field type single line
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Where will you keep your pet at night?*field type single line
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On average, how much time will the animal be left alone each day without human or pet interaction?*field type single line
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Do you have a veterinarian?*field type radio button
Do you have a veterinarian?YesNo
Veterinary Clinic Name*field type single line
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Veterinary Clinic Phone Number*field type single line
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Who is listed at the veterinary clinic as the pet's owner?*field type single line
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Do you currently have any pets?*field type radio button
Do you currently have any pets?YesNo
Have you had any pets in the last three years?*field type radio button
Have you had any pets in the last three years?YesNo
Other Pets
Please tell us about any pets you have had in the past three years
×
- Pet Type*field type radio button
  Pet TypeCatDog
- Name*field type single line
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- Breed*field type single line
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- Age*field type single line
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- Sex*field type radio button
  SexMaleFemale
- Spayed/Neutered*field type radio button
  Spayed/NeuteredYesNo
- Do you still have this pet?*field type radio button
  Do you still have this pet?YesNo
- Commentsfield type multi line
Add Additional Pet

Background

The following questions MUST be answered. If you have questions, please ask a staff member.

Are all pets currently on rabies vaccinations by a licensed veterinarian?*field type radio button
Are all pets currently on rabies vaccinations by a licensed veterinarian?YesNo
What veterinary clinic do you use for vaccinations?*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Who is listed at the veterinary clinic as the pet's owner?*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Is there anyone else in your household?*field type radio button
Is there anyone else in your household?YesNo
Do others in your household know you are planning to adopt a pet?*field type radio button
Do others in your household know you are planning to adopt a pet?YesNo
Is anyone in the home allergic to animals?*field type radio button
Is anyone in the home allergic to animals?YesNo
What type of allergies?*field type single line
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Do you want an indoor or outdoor pet?*field type radio button
Do you want an indoor or outdoor pet?IndoorOutdoorIndoor & Outdoor
Do you understand and will you comply with the City of Fayetteville's leash law?*field type radio button
Do you understand and will you comply with the City of Fayetteville's leash law?YesNo
Are there any behavioral issues that may cause you to return the pet to the shelter?*field type radio button
Are there any behavioral issues that may cause you to return the pet to the shelter?YesNo
What are they?*field type single line
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Why do you want to adopt at this time?field type multi line
How did you hear about our adoption program?field type multi line
By signing below, I certify that all information provided will be found to be true and that any misrepresentation of facts, on my behalf, may result in denial of adoption.
I understand that:
- Pets up for adoption are the sole property of Fayetteville Animal Services.
- Filling out this application does not guarantee me a pet. Placement of animals is at the discretion of Fayetteville Animal Services.
- I am authorizing investigation of all statements I have provided on this application.
- A representative of Fayetteville Animal Services may contact me in the future to follow up on the success of this adoption.
- Although Fayetteville Animal Services has provided initial vaccinations and spay/neuter surgery, all pets should see a veterinarian in the first few weeks after adoption.
- Any pet adopted from Fayetteville Animal Services may require special training for behavioral problems and I understand that it will be my responsibility to try to resolve these issues before returning the pet to Fayetteville Animal Services.
- The adoption fee is non-refundable.
Signature*field type signature
Date*field type date
Date and Time Submittedfield type date

Pet Adoption Application

Applicant Information

Home Information

Pet Information

Background