Pet Dog Adoption Form | Fidelco Guide Dog Foundation

Phone

This field is for validation purposes and should be left unchanged.

This is for pet dog adoptions only. This is not for prospective clients interested in guide dog partnerships or prospective volunteer puppy raisers. Thank you.

Today's Date

Applicant's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

Phone (Day)*

Phone (Evening)*

Household/Pet Experience

Have you owned a dog before?*

Yes
No

If "YES", list Breed(s)*

Have you had a Fidelco Shepherd before?*

Yes
No

If you have ever obedience-trained dogs, please describe

What became of your most recent dog(s)?*

Are there any of the following in the home? (check all that apply)*

Children (family members)
Children (frequent visitors)
Individuals with dog allergies
Senior Citizens (family members)
Senior Citizens (frequent visitors)
Persons with special needs
None of the above

Your Age*

Please list all other people residing in your home with ages*

What sort of exercise can you provide for the dog? (check all that apply)*

Fenced yard
Jogging
Leash walking
Other

Other*

For how long each day will the dog be alone?*

Dog will live primarily*

indoors as a house pet
outdoors in a doghouse

Describe age, sex, spayed/neutered, and breed(s) of other dog(s) in the home, if any*

Do you have pets other than dogs in the home?*

Yes
No

If "YES", please describe*

Pet Request

Do you want a Fidelco dog primarily for (check all that apply)*

Family pet
Companionship
Watchdog
Obedience Competitions
Other

Do you prefer a (check all that apply)*

Puppy (under 2 years of age)
Mature dog (over 2 years of age)
Retired dog

Do you prefer a*

Male
Female
Either male or female

Would you consider adopting a dog, at no charge, with a medical problem that may require medication, exercise restrictions, or other special needs?*

Yes
No

Financial Stability

Are you employed?*

Yes
No

Employer*

Address*

Job Title*

Do you have the ability to financially support a pet (approx $140 per month)?*

Yes
No

Monthly household income*

Criminal Record

Have you ever been arrested or convicted of a crime?*

Yes
No

If "YES", please include dates and details*

Personal References

Personal Reference #1*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Relationship*

Years*

Personal Reference #2*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Relationship*

Years*

Your Veterinarian

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Additional Comments or Information

Is there anything else you would like us to know?