Full Name
Street Address
City, State, Zip Code
Email Address
Home Phone
Alternate Phone
How did you hear of FIDO's Companion, Inc.?	Petfinder.com Internet Search Vet Referral Friend/Family Referral Met us at an event Newspaper Ad Other
Name of Pet interested in adopting:
Why are you interested in this dog?
Who made the decision to adopt a dog?
Activity level you are looking for:	1 Low Activity Level 2 Low-Medium Activity Level 3 Medium Activity Level 4 Medium-High Activity Level 5 High Activity Level
Hours dog will be left home alone:
Place pet kept when home alone?
Percent of time pet kept outdoors:
Ability to work with housetraining:	I agree to work on housetraining Unable to work on housetraining
Housetraining techniques you'll use:
Reasonable monthly pet expenses:
Current number of pets you have:
Types of pets you have (ie: dog, cat):
Is it ok to leave pet outside alone?	Yes it is ok No it isn't ok It depends on the circumstances
Under what circumstances is it ok?
Pet Id you'll have on your pet:	Collar embroidered w/ phone# County License Information Tag (Pet ID Tag) Microchip Tattoo Rabies Tag None
# of pets you've had in last 5 yrs?
Where are those pets now?
Reasons you'd surrender a pet:	Moving & can't take pet with you Divorce Too much shedding Allergies Excessive Barking Aggression toward humans Aggression toward other animals New Baby Jumping Fence Kids lost interest in pet Pet not housebroken Not Getting Along with Other Pets Not Getting Along with Kids Medical Problems Increased Work Hours Behavior Issues/Problems NONE
Ever given away a pet?	Yes No
If yes, please explain "why":
Ever apply for a rescue pet before?	Yes No
If yes, name of rescue(s):
Did you adopt from them?	Yes No
If "no" explain "why":
Anyone in home have allergies?	Yes No
If "yes" indicate allergic to:	Dogs Cats Birds Horses Small Animals (gerbils, etc)
Will you take pet to obedience class?	Yes No Maybe
Your type of residence:	Apartment (Rent) Condo (Rent) Condo (Own) House (Rent) House (Own) Mobile Home (Rent) Mobile Home (Own) House Boat (Rent) House Boat (Own)
If renting name of landlord:
Landlord phone number:
# of and ages of family members in home:
Type of fence:	Yard isn't fenced in 6' privacy fence 5' privacy fence 4' privacy fence 6' chain link 5' chain link 4' chain link 6' iron fence 5' iron fence 4' iron fence
Exercise you'll provide if no fence:
Name of Current Vet:
Phone number of vet:
1st Personal Reference (Name & Ph#):
2nd Personal Reference (Name & Ph#):
Do you object to a home visit?	No, we don't object to a home visit Yes, we object to a home visit
"Digital Signature" (initial here):