"Thank you for your interest in helping a
dog have a second chance at life."
I am interested in:
Please enter the name of the
dog you are interested in*:
What website did you find the dog you are interested in?
2.)*In Case of
Adoption: Just in case the dog you were interested in has already been
adopted or promised to someone else, please fill out the following
information. We may still be able to match you up with another furry
friend!
What breed would you be most
interested in adopting?
What sex would you be
interested in adopting?
What age dog are you most
interested in adopting?
The oldest dog you would be
willing to adopt would be:
Would you be willing to
accept
a dog with some health problem?
Would you be willing to
accept
a dog with some behavior problem?
3.)
Personal Information
*Indicates a required field
First Name*:
Last Name*:
Address 1*:
Address 2:
City*:
State*:
Zip Code*:
E-Mail*:
Home Phone*:
About Your Employment*:
Employer Name:
(If applicable)
Cell Phone*:
Best Time to Call?:
Personal Reference NOT Related to You*:
Personal Reference Phone*:
Personal Reference E-Mail:
4.) About Your Home
*Indicates a required field
Type of home*:
If you rent, does your lease
allow dogs?*
Landlord's Name:
Landlord's Phone:
Length of time at current
address*:
Do you have a swimming pool?*
Yes
No
Marital Status:
What are the ages of the
adults in your home?*:
If there are children in
your family, what are their ages?* (Check all that apply)
No
children
Middle
School
Under 1 year
Junior
High
Toddler
High
school
Grade
school
College
Is your yard fenced?*
Yes
No
Fence Height in Feet:
Type of fence:
If you don't have a fence,
how will you provide toileting & exercise for a dog?
5.)
Your Plans if You Adopt/Foster a Dog
*Indicates a required field
Where will the dog be when
you are home during the day?* (Check all that apply)
Loose Indoors
Crate
Kennel Run
Loose Outside
in Fenced Yard
In the
Basement
Tied/Chained
Outside
In a Garage
Other
Where will the
dog be when you are away during the day?* (Check all that apply)
Loose Indoors
Crate
Kennel Run
Loose Outside
in Fenced Yard
In the
Basement
Tied/Chained
Outside
In a Garage
Other
How many hours per day would
the dog spend alone?*
Where will the dog sleep at
night?* (Check all that apply)
Loose Indoors
Crate
Kennel Run
Loose Outside
in Fenced Yard
In the
Basement
Tied/Chained
Outside
In a Garage
Other
How do you plan to
discipline this dog?*
Do you plan to attend
obedience classes with this dog?*
Yes
No
If you decided to move, what
would you do with this dog?*
If you could not keep this
dog for any reason, would you return it to FOHA rescue?*
Yes
No
6.) Your Pet Ownership History
*Indicates a required field
Do you currently have any
pets?*
Yes
No
Please list any other pets
names, breeds, sex and ages:
Are all your other pets
spayed or neutered?*
If your pets are not spayed,
please tell us why:
How many pets have you owned
in the past 5 years?*
If any of the pets in the
last 5 years are no longer with you, please tell us why:
If you have had a pet die
while in your home, please tell us what happened:
Have you ever given a pet up
for adoption, or put a pet to sleep*?
Yes
No
If you answered yes, please
provide details:
Veterinarian for Reference*: (If you do not have a Vet, please enter the name of a 2nd personal
reference.)
Vet or Reference Phone*:
Prior Veterinarian:
Prior Vet's Phone:
Is there anything else you'd
like us to know about you:
This application must be sent online by clicking the
submit button below. We are not accepting faxes at this time.
-- If this application is incomplete,
please be aware that you will probably recieve an error message. By clicking the "Submit" button,
you certify that all the information on this application is
true and complete to the best of your knowledge.--
To report problems about the website
please e-mail the webmaster
