Dog Adoption Application FOWA Dog Adoption Form Step 1 of 4 25% How did you hear about FOWA Rescue?* FOWA Rescue Website Facebook A Friend Another Rescue Pet Finder An Adoption Event Which dog are you interested in adopting?* Name First Last Address* Street Address Address Line 2 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 Email Primary Phone*Secondary PhoneEmployer Employer Address Street Address Address Line 2 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 Vet InformationCurrent Vet Name Vet Phone NumberVet Address Street Address Address Line 2 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 PLEASE CONTACT YOUR VET AND GIVE YOUR PERMISSION TO SPEAK WITH US ABOUT YOUR PETS. IF THEY DO NOT HAVE YOUR PERMISSION, IT MAY DELAY THIS PROCESS.Previous Vet Name (If you have been there within the last 5 years. Prior Vet PhoneOther Pets InformationDo you own other dogs?* Yes No Provide name, breed, age, gender and if they are spayed/neutered.Do you own cats? Yes No How Many Cats? Are they Indoor Outdoor Both Please list any other animals in home (hamsters, ferrets, rabbits, etc.):Please list any previous pets, noting name, species, breed and length of ownershipHave you ever re-homed a pet? Yes No please explain the circumstances. About Your HomePlease list names and ages of all adults in home (one per line)Please list names and AGES of all children who live in the household at least part time One per line):Do you Own or Rent your home: Own Rent Which best describes your current home?Single Family HomeApartmentTownhouseDuplexMilitary HousingOtherPlease explain Please provide us with the property owner’s name Property Owners PhoneProperty Owners Address Street Address Address Line 2 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 How long have you lived at your current address? Does your home have a fenced yard/area?NoYes, fully fence on four sidesYes, partially fencedOtherFence TypeWoodChain LinkVinylInvisible FencingFence Height If you do not have a fenced yard, how do you plan to contain and exercise your dog?Do you work outside the home? Yes No How many hours will your dog be alone during the day? Where will your dog be kept during the day?Loose in the houseCrated inside the houseOutside in the yardGarage/basementDoggie daycareWith friend/family memberWhat are your plans for your dog? (Check all that apply) Pet/Companion Guard Dog Obedience Agility Therapy Other If Other, please explain How active is your home?Quiet/low key/few visitorsBusy/active family on the goLots of friends/kids in and outGrandkids visit regularlyRegular adult visitorsHow active would you like your dog to be?Low energy/couch potatoEasy going, walking companionActive/playful/ready to rompHiking or running partnerWhat issues might cause you to re-home your dog?Is they anything else you would like us to know? ReferencesPlease provide two references – No family and no one living with you. Include name, phone number, and relationship. Reference 1 Name: Reference 1 phone: Reference 1 relationship: Reference 2 phone: Reference 2 relationship: Reference 2 Name: Consent* I agree to the Acknowledgement and Release StatementAcknowledgement and Release Statement I hereby release to FOWA Rescue access to all veterinary and town license records of any or all of the animals I own or have owned. I certify that all the information in this application is true and I understand that false information may void the application. All adoptions are finalized at the discretion of the review board. FOWA Rescue reserves the right to refuse any adoption and will not reveal the specific reason for adoption denial. FOWA Rescue reserves the right to contact any individuals listed on this form. Electronic Signature (Type your name)* Date* MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
