Four Mile Critter Adoption Form
About You
First Name:___________________________________________________________
Last Name:___________________________________________________________
Recognition Name for Certificate & website (if different than above and not a gift):
____________________________________________________________________
Your Address
Street:_______________________________________________________________
City:__________________________State:________ Zip:______________________
Home Phone:________________________ Work Phone:______________________
Email Address:________________________________________________________
 Yes! I’d like to receive occasional e-mail updates & news from Four Mile Historic
Park. Four Mile Historic Park will not sell your e-mail address to any third parties.
This Adoption is:
 NEW
 RENEWAL
 GIFT
Gift Adoption? Please provide Four Mile Critter Adoptive Family information.
Recipient’s Name(s), Will also appear on Certificate and FMHP Website:
Name(s):
________________________________________________________________
_______________________________________________________________________
_
Recipient’s Address:
Street:_______________________________________________________________
City:__________________________State:________ Zip:______________________
Home Phone:________________________ Work Phone:______________________
Email Address:________________________________________________________
Would you like the adoption materials to be sent to you or the recipient?
 ME-Giver  Recipient
Occasion of Gift:_________________________________________________________
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