Delta Dawg Foster/Adoption Application

Friends of the Delta Dawg Adoption/Foster Application
6397 Highway 44

Helena, AR 72342

friends.delta.dawg@gmail.com
This application is designed to help Friends of the Delta Dawg determine if a specific dog is the right one for you and your household. All adopting or fostering parties are required to complete this form. Friends of the Delta Dawg reserves the right to deny any adoption or foster home based on answers to this questionnaire and/or interviews.
Applicant Information
Are you interested fostering or adopting:*
Name of the dog you are interested in:*
Your full name:*
Your age:*
Street Address:*
City, State, Zip*
Home Phone:*

Area CodePhone Number
Work Phone:*

Area CodePhone Number
Cell Phone:*

Area CodePhone Number
E-mail:*
Employer:*
Personal reference and phone number:*
I agree to send a copy of my Driver's License or state ID to Friends of the Delta Dawg if my application is approved.*

YesNo
Household Information
Are all members of your household in agreement with this adoption?*

YesNoUnsure
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile Home
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:*
Does your landlord allow dogs?*

YesNoN/A
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Do you have a fully fenced yard?*

YesNo
Height and type of fence*
Do you have any of the following?*

Underground fenceKennelDog RunNone
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?*
Have your children been around animals before?*

YesNoN/A
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
Current/Previous Pet Information
List any pets you own or have owned in the past five years, and their ages*
Where are these animals now?*
How many of these pets are spayed/neutered?*
Are your current pets up to date on all vaccinations?*

YesNoN/A
Are your current pets on heart worm preventatives?*

YesNoN/A
If yes, what kind? *
Are your current pets on flea/tick preventatives?*

YesNoN/A
If yes, what kind?*
Have you fostered or adopted from an animal welfare group before?*

YesNo
If yes, what group?*
Have you ever given up a pet?*

YesNoN/A
If yes, what were the circumstances?*
Please provide the name and phone number of your current and/or previous veterinarian or clinic:*
I give Friends of the Delta Dawg permission to contact my vet for references.*

YesNoN/A
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Where will your new pet live?*

Inside your homeOutside your homeBoth inside and outside
If new dog will live both inside and outside, how many hours a day will they be outside? *
If your dog is outside, how do you plan to keep your them in your yard?*

On a chain or tie outInside a fence untetheredElectric fenceI don’t, they will roam freely
Are you familiar with crate training?*

YesNo
Have you ever house-broken a dog or puppy before?*

YesNo
If the dog has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
Where will your new pet sleep at night?*
Where will your new dog stay when nobody is home or you are on vacation?*
What length of time will you allow your new pet to adjust to their new home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
Do you understand that a dog can be an 15 year commitment, and can cost $300 - $500 per year to care for?*

YesNo
What circumstances would lead you to surrender your new pet?*
I agree that if I no longer want the dog I adopted or are fostering, I will return it to Friends of the Delta Dawg. I understand that I cannot re-home or take the dog to another rescue or shelter.*

YesNo
Signature*

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Friends of the Delta Dawg Adoption/Foster Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information