Friends of Canines Animal Rescue Adoption Application
Please fill out the information in the fields below. If information for any of the fields is not available, please enter N/A for those fields. Please contact us via e-mail at
rescue@friendsofcanines.org
or by phone at (209) 832-2783 if you have any problems with this form.
Information about you
Your Name (required field):
Name of your spouse or partner, if applicable:
Email (required field):
Address:
City:
State:
Zip:
Home Phone Number:
Cell Phone Number:
Your employer:
Spouse/Partner employer:
Do you or your spouse/partner require frequent travel?
Please select
Yes
No
Are you or your spouse/partner subject to relocation?
Please select
Yes
No
If you checked yes to any of the two questions above, please explain:
Are you and/or your spouse/partner a student?
Please select
Yes
No
Are you and/or your spouse/partner in the military?
Please select
Yes
No
If you checked yes to any of the two questions above, please list your anticipated graduation or discharge date:
Family Information
How many children are living at home?
Please list the names and ages of all children living at home:
Besides the children listed above, are there any others residing in your home:
Please select
Yes
No
If so, please list their names and relationship to you:
Is anyone in your home allergic to animals?
Please select
Yes
No
Does anyone have asthma?
Please select
Yes
No
If you checked yes to any of the two questions above, please explain:
Home Information
How long have you lived at your current address?
If less than two years, please provide your previous address:
Please describe your neighborhood:
Please select
City
Suburb
Country/Rural
Please describe your type of dwelling:
Please select
Apartment
Duplex/Triplex
Townhouse/Condominium
Mobile Home
House
Farm/Ranch
Do you own or rent your property?
Please select
Own
Rent
If you rent, please provide the name and phone number of your landlord:
Does your home have a yard?
Please select
Yes
No
If yes, please describe restraint system (check all that apply):
Run loose in the yard
Tie-out
Dog run
Invisible fence
Conventional fence
If your yard is fenced, please describe what kind(s):
How tall is/are your fence(s)?
Do your dog(s) have access to any toxic plants in your house or yard (e.g. Oleander):
Please select
Yes
No
Unsure
If yes, please describe:
Is your gate currently locked with a padlock?
Please select
Yes
No
Can strangers gain access to your yard from the street?
Please select
Yes
No
Would you be open to having a representative of Friends of Canines Animal Rescue come to your house and do a home check?
Please select
Yes
No
Other Pet Information
Do you have other pets at this time?
Please select
Yes
No
If yes, are they spayed or neutered yet?
Please select
Yes
No
Not all of them
If yes, are they currently on heartworm preventative?
Please select
Yes
No
Not all of them
If yes, are they indoor or outdoor pets?
Please select
Indoor
Outdoor
Both
Please describe your pets in detail below. For each pet, list type or breed, name, age, gender, whether the animal is spayed or neutered, whether the animal is indoor, outdoor or both, as well as any special likes or dislikes he or she has.
Have you ever owned a dog before?
Please select
Yes
No
If you are currently owning a dog or have owned a dog in the past, how do or did you exercise them?
If you have owned pets in the past and do not own them any longer now, what happened to them?
Placement Information
Are you looking for primarily an indoor or an outdoor dog?
Please select
Indoor
Outdoor
Both
What role would you like your new dog to play in your life? Please check all that apply:
Companion / Pet
Obedience
Protection
Therapy
Hunting
Other roles (please specify):
Please describe where the dog will stay when you are at home:
Please describe where the dog will sleep at night:
Please describe where the dog will stay when you are gone during the day:
How many hours a day will your dog be alone?
Do you have a crate?
Please select
Yes
No
Do you plan to use a crate?
Please select
Yes
No
Why or why not?
If you plan to use a crate, how many hours a day will the dog be crated?
Do you currently have a dog door?
Please select
Yes
No
If no, would you consider putting one in?
Please select
Yes
No
What kinds of solutions would you be willing to try if housebreaking accidents occurred? Please check all that apply.
Crate
Dog door
Keep dog outside
None, I would need to return the dog
Other solutions (please specify):
Please describe where the dog will stay when you are away on vacation or otherwise gone for more than a day?
How do you plan on exercising your dog?
Are you familiar with signs of gastric torsion (bloat)?
Please select
Yes
No
References
Do you have a current veterinarian?
Please select
Yes
No
If so, please provide us with your current veterinarian contact information:
Name:
Address:
City:
State:
Phone:
If you have had your current vet for less than 5 years, please provide us with your previous veterinarian information:
Name:
Address:
City:
State:
Phone:
Please provide a personal reference who is not related to you:
Name:
Daytime phone number:
Evening phone number:
And Finally ...
Do you have a gender preference?
Please select
Male
Female
Either
Do you have an age preference?
Is there a dog on our web page that you are especially interested in?
If you were referred by anyone, please tell us so we may thank them:
Please give us any other information that may help us determine which dog may be the best fit for your family:
Thank you for filling out our adoption application. Please click "Submit" below to send the application to us.