Special Animal Friends and Rescue, Inc (SAFARI)

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Adoption Applicant 1 Information

Will there be 1 or 2 applicants?(*)

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Full Legal Name:(*)

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Preferred Name:

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Age(*)

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Birth Date must be in the format MM/DD/YYYY. Click the calendar button to open a calendar for selection. From the calendar, clicking on the Month Year display in the header of the calendar will allow you to type your 4 digit birth year

Birth Date:(*)

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Email:(*)

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Re Enter Email:(*)

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Street Address(*)

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City(*)

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State:

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Zip Code:(*)

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Main Cross Roads(*)

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Driver's License #, DL State (or None):(*)

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Home Phone:

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Cell Phone:

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Work Phone:

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Employer Name:

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Employer City:

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Usual Work Hours:

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Emergency Contact Name:(*)

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Emergency Contact Phone:(*)

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Emergency Contact Relation(*)

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References

Reference 1 Name(*)

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Reference 1 Phone(*)

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Reference 1 Relation:(*)

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Reference 2 Name(*)

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Reference 2 Phone(*)

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Reference 2 Relation:(*)

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Adoption Applicant 2 Information

Full Legal Name:(*)

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Preferred Name

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Relation to Applicant 1(*)

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Age(*)

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Birth Date:(*)

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Email:

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Re Enter Email:

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Driver's License #:(*)

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Cell Phone:

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Work Phone:

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Employer Name:

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Employer City:

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Usual Work Hours:

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For your telephone interview, please suggest a best day(s) and time(s) when an adoption coordinator could reach you (or both of you if there are two applicants).

Best Day(s) and Times

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Best Phone Number(*)

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In order for your application to be reviewed, it is mandatory that all questions be answered completely. Thank you for your patience in completing this form as it helps us find responsible, loving, permanent homes for the animals. Please be advised that the application screening may take up to two weeks. In most cases, a home inspection and a vet check will be required before an application can be approved. Special Animal Friends and Rescue, Inc. reserves the right to decline an application. If you are not contacted within two weeks, your application was not approved, or the animal was placed with another family.

By clicking submit below, I/We are certifying that all the information provided is true to the best of my/our knowlege, complete, and not misleading in any way. I/We are also authorizing Special Animal Friends and Rescue, Inc.(SAFARI) to contact landlords, associates, references and veterinatrians as well as the opportunity to conduct a home visit.

After clicking submit, a copy of your completed application will be forwarded to your listed email(s) and you shall be taken to a thank you screen. Please only click the submit button once, processing can take a minute or two.