Adoption Application

DOG (OR KIND OF DOG) YOU’RE INTERESTED IN ADOPTING
Pets Name
Gender
- Male
- Female
Breed
Age
Adopter Information
Applicant*
Age*
Occupation*
Co-Applicant Name
Co-Applicant Age
Co-Applicant Occupation
City
Address*
County*
State*
Zip*
Home Phone
Cell Phone
Email*
Employer
Work Phone
List names and Ages of ALL others that live with you
I am*
Do ALL of the members of your home want this pet?*
Is this pet a gift?*
If Yes, For whom?
Are you willing to allow a representative from FHCR visit your home by appointment?*
Do You*
Type of Home*
If you rent, name of landlord or real estate company:
Landlord Phone
May we check your lease for a pet clause?
How much is the pet deposit?
Do you have a fenced yard?
What kind of fence?
How long have you lived at this residence?*
Do you have landlord’s permission to have dog?
Will the dog live in a smoke-free home?*
Fence Height
Doggy Door?
Is anyone in the home allergic to animals?*
Who is allergic and to what?
How many hours will your dog be home alone on a typical week day?*
On weekends?*
Where will your new dog stay when home alone during the day?*
Where will your new dog stay/sleep at night?*
If your pet will be living outside, please describe its living facilities:
If you are no longer able to keep your dog for any reason, at any time, will you return the dog to us?*
If you date or marry someone who does not like your pets, what would you do?*
What kind of temperament are you looking for in a pet?*
Please describe your family (i.e.: are you active and on the go, or homebodies. Please be as specific as possible)*
How many pets do you have at home now?*
How many have you had in the past 5 years?*
Please list all pets you currently have, and have had in the past five years, and what happened to them:
Name Species Breed Age Spayed/Neutered? Living/Deceased Vet Used
Do you know about heartworm disease and how to prevent it?*
Do/did you keep your pets on heartworm prevention medication?
What brand do you use?
How do you plan to prevent fleas and ticks?*
Has a dog or puppy died on your premises in the last 6 months of distemper, Parvo, or other contagious causes?
Veterinarian Information
Please make sure that all pet and veterinarian information is accurate and up to date. We do check references carefully and will reject an application solely on the basis of discrepancies found. If you have moved recently and/or have changed veterinarians, please make us aware of this so that the information we procure will match what is in your application. Your veterinarian may require verification from you in verbal or written form that you authorize him/her to release information to the FHCR. Information from veterinarians is completely confidential and cannot be discussed with the applicant once the reference check is completed. By filling out and submitting this application I hereby authorize any veterinarian named below to release any information and records concerning my past or present care of animals to whomever presents this application. By checking "YES" below, I give my permission for the FHCR to contact the veterinarian named below, and for him/her to release all information and records concerning my past or present care of animals.
- Yes
Name of the Veterinary Clinic you use the most:
Vet Phone
Vet Street Address
Vet City
Vet State
What do you expect annual pet care (vet care, medications, heartworm preventative, etc.) to cost yearly?*
Are you willing to keep vaccinations up-to-date and provide adequate medical care for this pet?*
Suppose your dog develops a medical problem that becomes expensive, but has a good quality of life. What would you do?*
What food do/did you feed your pets?
If you are considering a long-haired breed, how often would the dog be groomed?
Would You
- Do it yourself?
- Have a Groomer do it?
How much would you expect it to cost?
Please list your groomer’s name and phone number:
Who will be responsible for the daily care and training of your new dog?*
Are you willing to go to obedience training with your dog if necessary?*
Are you willing to keep a collar, ID tag, and rabies tag on all of your pets including your new dog at all times?*
Where did you hear about Forever Home Canine Rescue?*
If you do NOT have a veterinary reference, please list the name, address and phone number of a personal, non-related and non-significant other as a reference:
By checking "I Agree" below, I am attesting to the truthfulness of my answers. Falsification of any of the above information is grounds for disallowing the adoption of the rescue dog and possible removal of said dog from my home.*
- I Agree

DOG (OR KIND OF DOG) YOU’RE INTERESTED IN ADOPTING

Adopter Information

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Name	Species	Breed	Age	Spayed/Neutered?	Living/Deceased	Vet Used