Thank you for taking the time to fill out this application. Your information will remain confidential and used only as part of the FDR Dog Adoption Program.

1. Fill out this online form and submit it. You will receive an email with a copy of the form in PDF format.
2. Please print out the form and bring it with you to any meet & greets or adoption events.
3. If you adopt a dog you can sign the form at that time.

Email *
First & Last Name *
Street Address *
City *
State *
Zip *
Home Phone
Work Phone
Cell Phone *
California drivers license or identification card number
How did you hear about us
Why do you want to adopt a dog now?
What is the name of the dog you are interested in adopting? *
Is everyone in the home in agreement with the decision to adopt a dog now?
What type of dog are you looking for?
What age dog are you looking for?
Type of coat
Gender preference of dog
Clear selection
Activity level
Clear selection
Have you owned this type of dog before
Clear selection
Is it necessary that the dog already have training
Basic Obedience
Other training
How many adult are in your household (including yourself)?
How many children
Ages of children
Does anyone in the household have allergies to dogs?
Clear selection
If yes, who?
Do you live in *
I *
How long have you lived at this address
If renting/leasing, are there pet restrictions
Clear selection
If yes, what are they?
Landlord's name
Landlord's phone
Pet #1 - Please tell us about your pet: Name, breed, age, how long owned, and do you keep them inside / outside / both
Pet #2 - Please tell us about your pet: Name, breed, age, how long owned, and do you keep them inside / outside / both
Pet #3 - Please tell us about your pet: Name, breed, age, how long owned, and do you keep them inside / outside / both
Tell us more about your pets
Not altered
Pet #1
Pet #2
Pet #3
Who will be the primary caretaker of your adopted dog(s)?
Describe the time the caretaker usually spends away from home *
Where will the dog stay during the day?
Where will it stay at night?
Where will the dog stay when the caretaker is not home?
Describe your yard
Clear selection
Height of fence?
Fence material
Clear selection
If you don't have a fenced in yard, do you agree to keep your adopted dog on leash at all times when outside?
Clear selection
Who will have financial responsibility for this dog?
How would you describe your level of experience with dogs? (check all that apply)
If you have previous experience foster/rescue experience, please describe
Are you willing to train your adopted dog? What type of behaviors do you know how to teach (example: house-training, basic commands, leash skills, etc) Note: FDR can provide information on training resources in the area, please ask our representative
How would you describe you & your family member's overall activity level (active, noisy, quiet, sedentary)
How will the dog be exercised?
Do you agree to provide regular health care by a licensed Veterinarian?
Clear selection
Please provide name & number of your current Vet
Please provide the name and phone number of at least one reference that FDR may contact, preferably as man as three, who is familiar with you as a pet owner:
Will you consent to FDR conducting a visit to your home prior to the approval and/or finalization of any dog adoption if FDR determines it is appropriate?
Clear selection
Do you agree to contact FDR if you can no longer keep this dog?
Clear selection
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