Friends of Rocky Mount Animals - Pet Adoption Application

Due to technical difficulties we've been experiencing with the online adoption application on this page, it is recommended that the application instead be downloaded in .pdf or .doc format using one of the following provided links:
        (.pdf is the recommended download format)
Once downloaded...
1. Open the file outside of your browser to complete
2. Save the completed file and e-mail it to
We apologize for any inconvenience. We are trying to make the application submission process as easy as possible so that our precious furbabies can find their forever homes!
If you'd like to attempt using the below online application, be advised that it isn't working for everyone and for some, there is a wait time of up to 2 minutes after clicking the "Submit" button before it will submit successfully.
**You will see a confirmation message if it submits successfully.**
Applicant’s Name *
Phone (H)*
Phone (C)*
Why are you choosing to acquire a new pet?
Name of pet(s) you are interested in adopting:
Are you looking for a Puppy  Dog  
A. age range (min./max.)
B. Sex male  female  
C. weight range (min./max)
D. good with children? yes  not necessarily  
   (please anticipate whether you plan to have children in the future)
E. good with dogs? yes  not necessarily
F. good with cats? yes  not necessarily 
G. house-broken? yes  not necessarily 
H. activity level? active  moderate  “couch potato” 
                            Please list all members of your household (including yourself):
Name 1
Age 1
Relationship 1
Name 2
Age 2
Relationship 2
Name 3
Age 3
Relationship 3
Who would have primary responsibility for taking care of your new pet?
Do you/your family reside in house  townhouse apartment  
Do you own or rent your home? Own  Rent  
How long have you lived at present residence?
(Please note: If you rent, you must provide a note from your landlord verifying that you
are allowed a pet or a copy of the lease indicating pets are allowed.)
Are you/your spouse currently employed? Yes  No  
Place of employment
Work schedule
Does your schedule allow you to go home on breaks? Yes  No  
Approx. how many hours total per day are you away from home?
Which of the following best describes your family's lifestyle? (select all that apply)
Active / Outdoorsy (jogging, hiking, etc)  
Relaxed / Leisurely (reading, tv, gardening, etc)  
"On the go"
Very social / Entertains company frequently
"Home-bodies" / Usually home outside of work 
Travels frequently  
How would you describe your family’s household? Quiet/Relaxed  Active/”busy” 
Are you looking for a pet for
Primarily inside  Primarily outside 
Inside only  Outside only 
Approx. how many hours/day will your pet spend inside?
Approx. how many hours/day will your pet spend outside?
Where will your pet be kept while you are away from home?
Where will your pet be kept while you are home?
Where will your pet sleep?
Where will your pet be kept when outside? fenced yard  dog pen  tie out  
free in yard  on leash  
Will your pet have access to dog house  garage  house (doggie door)  
How do you envision spending time with your pet?
Do you plan to crate-train (for dogs)? Yes  No  
How many hrs./day total will your dog be crated?
Species (Pet 1)
Name (Pet 1)
Age (Pet 1)
Indoor or Outdoor? (Pet 1) Indoor  Outdoor  
Spayed/Neutered? (Pet 1) Yes  No  
Current Vaccinations? (Pet 1) Yes  No  
Heartworm Prevention? (Pet 1) Yes  No  
Length of time owned (Pet 1)
Current or Previous (Pet 1)
Species (Pet 2)
Name (Pet 2)
Age (Pet 2)
Indoor or Outdoor? (Pet 2) Indoor  Outdoor  
Spayed/Neutered? (Pet 2) Yes  No  
Current Vaccinations? (Pet 2) Yes  No  
Heartworm Prevention? (Pet 2) Yes  No  
Length of time owned (Pet 2)
Current or Previous (Pet 2)
Species (Pet 3)
Name (Pet 3)
Age (Pet 3)
Indoor or Outdoor? (Pet 3) Indoor  Outdoor  
Spayed/Neutered? (Pet 3) yes  no  
Current Vaccinations? (Pet 3) yes  no  
Heartworm Prevention? (Pet 3) yes  no  
Length of time owned (Pet 3)
Current or Previous (Pet 3)
Name and phone number of your current (or previous) vet clinic
Vet records are under the name of*
How long have you been/were you a client?*
(if less than 3 yrs., please provide an additional vet)*
In which of the following situations you might consider giving up your pet*
allergies (self/ family) 
children have lost interest in it
no longer have time for it 
damages household objects  
moving / new residence won’t allow pets 
new marriage / mate doesn’t like pets 
Please the name of two other persons to be contacted as references:
Reference Name 1*
Reference Number 1*
Relationship 1*
Reference Name 2*
Reference Number 2*
Relationship 2*

**There may be a long delay (up to 2 minutes) upon submitting this online application**
You will see a confirmation message once the application is submitted successfully.