Full Name:*    
  Street Address:*    
  City, State, Zip Code:*    
  Email Address:*    
  Home Phone:*    
  Alternate Phone:   
  How did you hear of FIDO's Companion, Inc.?
  

  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:
  

  Hours dog will be left home alone:*    
  Place pet kept when home alone?*    
  Percent of time pet kept outdoors:*    
  Ability to work with 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?
  

  Under what circumstances is it ok?:   
  Pet ID you'll have on your pet:   





  Number of pets you've had in last 5 yrs?*    
  Where are those pets now?:   
  Reasons you'd surrender a pet:   















  Ever given away a pet?
  

  If yes, please explain why:   
  Ever apply for a rescue pet before?
  

  If yes, name of rescue(s):   
  Did you adopt from them?
  

  If "No" explain why:   
  Anyone in home have allergies?
  

  If "Yes" indicate allergic to:   



  Will you take pet to obedience class?
  

  Your type of residence:
  

  If renting name of landlord:   
  Landlord phone number:   
  Number of and ages of family members in home:*    
  Type of 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?:
  

  Digital Signature (initial here):*    

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