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. Information about youYour Name* First Last Spouse or Partner Name, if applicable Email* Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneMobile PhoneYour employer Spouse/Partner employer Do you or your spouse/partner require frequent travel?Not SelectedNoYesAre you or your spouse/partner subject to relocation?Not SelectedNoYesIf you checked yes to any of the two questions above, please explain:Are you and/or your spouse/partner a student?Not SelectedNoYesAre you and/or your spouse/partner in the military?Not SelectedNoYesIf you checked yes to any of the two questions above, please list your anticipated graduation or discharge date:Family InformationHow 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:Not SelectedNoYesIf so, please list their names and relationship to you:Is anyone in your home allergic to animals?Not SelectedNoYesDoes anyone have asthma?Not SelectedNoYesIf you checked yes to any of the two questions above, please explain:Home InformationHow long have you lived at your current address? If less than two years, please provide your previous address: Please describe your neighborhood:Not SelectedCitySuburbCountry/RuralPlease describe your type of dwelling:Not SelectedApartmentDuplex/TriplexTownhouse/CondominiumMobile HomeHouseFarm/RanchDo you own or rent your property?Not SelectedOwnRent(Note that we do work with renters and have placed many pets in wonderful homes with people who rent.) If you rent, please provide the name and phone number of your landlord:Does your home have a yard?Not SelectedNoYesIf 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)?Not SelectedNoYesUnsureIf yes, please describe:Do you have a pool?Not SelectedNoYesIf yes, please describe the type of pool (e.g. in-ground or above-ground) and whether it is fenced off separately from the rest of the yard:Is your gate currently locked with a padlock?Not SelectedNoYesCan strangers gain access to your yard from the street?Not SelectedNoYesWould you be open to having a representative of Friends of Canines Animal Rescue come to your house and do a home check?Not SelectedNoYesOther Pet InformationDo you have other pets at this time?Not SelectedNoYesIf yes, are they spayed or neutered yet?Not SelectedNoYesNot all of themIf yes, are they currently on heartworm preventive?Not SelectedNoYesNot all of themIf yes, are they indoor or outdoor pets?Not SelectedIndoorOutdoorBothPlease 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?Not SelectedNoYesIf 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 InformationAre you looking for primarily an indoor or an outdoor dog?Not SelectedIndoorOutdoorBothWhat role would you like your new dog to play in your life? Please check all that apply: Companion / Pet Obedience Protection Therapy Hunting Other If Other (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?Not SelectedNoYesDo you plan to use a crate?Not SelectedNoYesWhy 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?Not SelectedNoYesIf no, would you consider putting one in?Not SelectedNoYesWhat 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)?Not SelectedNoYesReferencesDo you have a current veterinarian?Not SelectedNoYesIf so, please provide us with your current (less than 5 years ago) veterinarian contact information:Name Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneHave you had a previous veterinarian in the last 5 years?Not SelectedNoYesIf so, please provide us with your previous veterinarian information:Name Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhonePlease provide a personal reference who is not related to you:Personal Reference Name First Last Daytime PhoneEvening PhoneAnd Finally ...Which pet(s) on our web page are you interested in? Please list his/her/their name(s): Or more in general: Do you have a gender preference?Not SelectedMaleFemaleEitherDo you have an age preference? What breed(s) are you 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.PhoneThis field is for validation purposes and should be left unchanged.