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The Foundation for the Care of Indigent Animals  ©  2014 - 2017  •  All Rights Reserved

What is the name of the animal you are applying for?
   
Name
Spouse / Roommate Name
Address
City, State, Zip
Home Phone Number
Work Phone Number
Email Address
Occupation (all applicants) Primary Applicant:

Spouse / Roommate:

   
Do any children live in, or visit, your home?
If yes, what are their ages?
If no, do you plan to have children in the future?
Does Everyone in my household wants the dog?
Is anyone in the household allergic to animals?
What type of home do you live in?
Other Type of Home: 
Do you own or rent your home?
If you rent, you must have landlord's permission to have a dog.

Please provide us with your Landlord Info.

Landlord Name:

Landlord Phone:

Do you have a fenced yard?
Please describe your fence: Type: 

Height:

Can people passing by see behind your fence?
Do you have a swimming pool?
If yes, is the pool fenced?
Dogs frequently drown in pools.  If your pool is unfenced, how do you plan to protect this dog?
Do you have a pond or jacuzzi in your yard?
   
Do you currently own any pets?
If yes, please provide the following information about each pet:
   
  Type of Pet
(dog, cat, bird, etc)
Breed Gender Spayed/Neutered Licensed
Pet #1
Pet #2
Pet #3
Pet #4
Pet #5
Pet #6

Have you owned other dogs in the past?
If yes, how many?
What happened to these dogs? (Be specific) 
If deceased, please state the cause of death and how long ago.
How did you obtain your previous pets?
Please provide the following information for your current or past veterinarian: Veterinarian / Clinic Name:

Address: 

Phone Number: 

  No current or past veterinarian

I agree to advise my vet that you will be phoning for medical information on my previous and current pets and we will also notify you when we have done so. I understand that this application will not be processed until this occurs. If I have had no previous pets/veterinarian services, this does not apply.
  Check if agree
Please provide the following information for your current or past groomer with previous/current pets: Groomer Name: 

Address: 

Phone Number: 

   No current or past groomer

Have you ever given up a dog?
If yes, please explain:
   
Why do you want this dog?

Please number as many choices as apply in order of importance.

  For my children

  As a companion for me

  For protection

  To give as a gift

  As a companion for my other pets

  Hunting

  Guard dog

  Other.  Please explain: 

Why did you choose this dog?
How did you learn about this dog?:
Are you willing to housebreak this dog?
How do you plan to exercise this dog?
Do you object to an inspection of your premises by an FCIA representative?
Who will be responsible for the care of this dog?
I realize that dogs require annual vaccinations and routine medical care.
 
  Check if agree

I estimate the cost to be about  $   per year.

I realize that at some time my dog may become sick or injured.
 
  Check if agree

I am   willing or   unwilling to provide the additional medical care if needed.

What is the maximum you expect to pay for medical per year?
I realize that dogs may live for 12 to 15 years or more   Check if agree
Do you agree to have this dog spayed or neutered (if not already)

If not, why not? 

Do you agree to have this dog licensed with your City / County?
Under what circumstances would you not be able to keep this dog? 
(Check all that applies)
  Divorce

  Move

  New Baby

  New Job

  Illness

  Other. Explain:

What would happen to your dog should something happen to you during its lifetime and you could no longer care for it?
Is there someone who could take this dog and care for it?  If so, who?

Name:

Address:

Phone:

What type of pet do they currently have?

Are you a frequent traveler?
If yes, how will you provide care for this dog while away?
I understand that the initial adjustment period between a dog and its new owner is critical.

How long do you plan to be with this dog before being left alone for any period of time?

    Hours

    Days

How many hours per day will this dog be left alone?
When you are away, where will this dog stay?
While you are at home, where will this dog stay?

If both (indoors & outdoors) how long with this dog be inside and how long outside?

Time outside:

Time inside: 

Please describe the outdoor shelter you have for this dog:
Where will this dog sleep?  (Be specific)
Will this dog have a doggie door?
If no doggie door, how will this dog be able to get in and out of the house?
I realize that dogs frequently left alone will dig, chew & bark.

How will you deal with these potential problems?

  Check if agree

Do you allow your dog(s) to run and play in public places (beach, park, etc) without a leash?
Are you willing to take this dog to obedience classes, if necessary?
Would you welcome more information about health, safety and training information for this dog?
   
  I understand that no adoption is officially approved unless signed by one of the Board of Directors of the Foundation for the Care of Indigent Animals (FCIA).
   
  BY SUBMITTING THIS APPLICATION, I CERTIFY THAT THE ABOVE INFORMATION IS TRUE, AND THAT ANY FALSE INFORMATION MAY RESULT IN NULLIFYING THE APPLICATION.

 

 

"The greatness of a nation and its moral progress can be judged by the way its animals are treated."
- Mahatma Gandhi