| * denotes a required field |
Dog's Information |
| Dog's Name: |
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| FOCAS ID Number: |
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| Breed: |
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| Color: |
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| Age: |
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| Sex: |
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Adopter's Information |
| * Name of Adopter: |
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| Street Address: |
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| City: |
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| State: |
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| Zip: |
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| * E-mail: |
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| Phone: |
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| Cell Phone: |
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| Occupation: |
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| Employer: |
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| Business Phone: |
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Home Residents |
| Name of Spouse or Roomate: |
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| Spouse/Roomate's Occupation: |
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| Spouse/Roomate's Employer: |
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| Spouse/Roomate's Business Phone: |
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What other animals do you currently own? Please list breed, sex and age of all pets.
Dogs: |
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| Cats: |
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| Other: |
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| Are your other dogs licensed?: |
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| If yes, where?: |
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| List the ages of all children living at home: |
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| Is anyone in your household allergic to animals?: |
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| If yes, to what animals?: |
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Your Plan |
| Who will be responsible for the dog?: |
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| * Why do you want a dog? For all of the reasons that apply, please number in order of importance (i.e. 1, 2, 3 etc.): |
For children
For spouse
As a gift
For other pets
For hunting
Companionship
Protection
Pet therapy
Other
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| Please be specific: |
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| Why have you chosen this particular dog?: |
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| How did you learn about this dog?: |
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| Please specify the name of the newspaper, web site, radio station, TV program or other source: |
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| Have you owned a dog before?: |
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| If yes, how long ago?: |
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| What happened to the dog(s)? (If deceased, please state cause of death): |
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| * Healthy dogs require annual vaccines and routine medical care. What do you estimate the cost to be per year?: | $
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| Are you willing to provide adequate medical care if this dog should become sick or injured?: |
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| Dogs can live longer than 15 years, and their care may cost more than $400 per year. Are you prepared to accept this kind of responsibility for the dog's entire life?: |
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| List the name of the veterinarian and/or the hospital where you will take the dog: |
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| Do you plan to spay/neuter this dog?: |
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| If not, why not?: |
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| Do you plan to license this dog?: |
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| How soon after the dog arrives home will it be left alone?: |
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| How many hours a day will the dog be left alone?: |
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| Dogs left alone frequently dig, chew and bark. How do you plan to deal with these potential problems?: |
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| How often do you travel: |
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| How do you plan to provide for the dog when you are out of town?: |
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| What will happen to the dog if you move locally?: |
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| What will happen to the dog if you move across the country?: |
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| What will happen to the dog if you move overseas?: |
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| Under what circumstances would you not keep this dog? Check all that apply: |
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| Please be specific: |
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Home Environment |
| Specify the type of home you live in: |
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| Please specify: |
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| How long have you lived there?: |
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| If less than two years, list previous address: |
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| Do you rent?: |
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| If yes, do you have your landlords permission to have a dog?: |
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| If you rent, may we contact your landlord?: |
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| Landlord's phone number: |
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| Date to best reach your landlord: |
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| Do you have a fenced yard?: |
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| If yes, how high is the fence?: |
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| Describe the type of fencing: |
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| Do you have a swimming pool?: |
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| If yes, how is it covered or fenced?: |
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| Where will the dog be kept when left alone?: |
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| Are you willing to attend training classes?: |
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| Have you inquired about training classes?: |
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| If yes, where?: |
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| Where will the dog be kept?: |
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| What kind of outdoor shelter is available for this dog?: |
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| On the first night home, where will the dog stay?: |
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| How would you describe your household activity level?: |
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| How do you plan to exercise the dog?: |
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| What types of activities would your dog participate in?: |
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| Will you allow an inspection of your premises by a FOCAS representative?: |
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Comments |
| Do you have questions or comments? Include them here: |
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| How did you hear about FOCAS?: |
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Certification |
| Certification: |
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