Adoption Application - Clementine

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FBV Adoption Application Fee

Please note: a $10 Non-Refundable Application Fee is required. Your application will not be processed without the fee. This fee helps to offset a small portion of our rescue’s expenses.
Contact Information
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Email
About You and Your Household
Age of applicant
Occupation of applicant
If you have a partner, what is the person's occupation?
Members of your household

Please list the names of ALL members in your household, along with their ages and relationship to you.
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
Additional Household Members

Please use this space if you need to add additional household members. Please list name, age and relationship.
Does anyone in your household suffer from allergies to dogs?

Does anyone in your household suffer from allergies to dogs? Yes No
Please list all pets in your household

List the name, type, breed, gender, age and whether or not the pet is altered.
Pet Name
Type of Pet

Dog, Cat, Snake, Bird, etc
Breed
Gender

Gender Male Female
Age
Altered

Altered Yes No
Pet Name
Type of Pet

Dog, Cat, Snake, Bird, etc
Breed
Gender

Gender Male Female
Age
Altered

Altered Yes No
Pet Name
Type of Pet

Dog, Cat, Snake, Bird, etc
Breed
Gender

Gender Male Female
Age
Altered

Altered Yes No
Pet Name
Type of Pet

Dog, Cat, Snake, Bird, etc
Breed
Gender

Gender Male Female
Age
Altered

Altered Yes No
Use this space to list any additional pets that are in your household. Please list Name, Type, Breed, Gender, Age, and whether or not the pet is altered.
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Enter Your Email Address *

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Adoption Application - Clementine

Adoption Application - Clementine

FBV Adoption Application Fee Please note: a $10 Non-Refundable Application Fee is required. Your application will not be processed without the fee. This fee helps to offset a small portion of our rescue’s expenses.

Contact Information

About You and Your Household

Members of your household

Please list all pets in your household

FBV Adoption Application Fee

Please note: a $10 Non-Refundable Application Fee is required. Your application will not be processed without the fee. This fee helps to offset a small portion of our rescue’s expenses.