Adoption Application APPLICANTFull Name First Last Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home Telephone Number*Mobile Telephone NumberEmail Address Name of the Dog you are interested in*Please note – we are only processing applications for dogs who are currently available on our Website or Facebook Page.ABOUT YOU AND YOUR FAMILYNumber of Adults in the Home*Please Select The Appropriate Age Ranges For The Adults* 18 - 35 36 - 50 51 - 70 71 + Number of Children in the Home*If Applicable, Please Enter The Number Of Children Under 10Do you go out to work?* Yes No If Yes, how many hours per day?Does your partner go out to work?* Yes No If Yes, how many hours per day?ABOUT YOUR HOME AND GARDENHave you ever owned a dog?* Yes No Do you currently own any other dogs?* Yes No If yes, please give details of breed, age, gender and whether they are neuteredHave you ever adopted a dog before?* Yes No Why do you want to adopt a Rescue dog?Do You Own Your Own Home?* Yes No Please note: If you live in rented accommodation you will need to have your landlord's written permission to keep a pet.Do You Have A Secure Garden?* Yes No Please indicate height of fencing/boundary at its lowest pointOTHER PETSDo you have any cats?* Yes No Are they familiar with dogs? Yes No N/A Do you have any other pets and/or livestock?* Yes No If yes, please state what animals you own?RESPONSIBILITY FOR AN ADOPTED DOGHave you taken into consideration the costs of owning a dog?* Yes No Where will the dog sleep?Where will the dog stay during the day?Would you be prepared to use an indoor crate if necessary?* Yes No If so where would it be placed?What will happen to the dog when you go on holiday?Are you aware of the different types of coat care required?* Yes No Are you prepared to groom yourself or pay for grooming?* Yes No Are you prepared to give the dog any necessary training such as classes?* Yes No Have you ever given up a dog to a rescue organisation?* Yes No ADDITIONAL INFORMATIONWhat activities are you hoping to do with your dog? e.g. Walking, Agility, Obedience, CuddlingPlease give availability for a Home Check to be carried out (FODDR would like to meet all the occupants of the home if possible)Have You Ever Had A Conviction For A Criminal Offence Involving Cruelty, Violence Or The Threat Of Violence To Other People Or Animals?* Yes No I declare that the information provided in this application form is true and accurate. I undertake to inform FODDR if/when we no longer wish to adopt a dogApplicant Digital Signature (Full Print Name)*Date*