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Friends of Contra Costa Animal Shelters
Your Custom Text Here
Home
Donate
About Us
About F.O.C.C.A.S
Meet The Team
Dogs & Cats We Have Helped
Proud Partners
Get Involved
Volunteer
The Running Dog
Delta View Cats
Adopt
View Adoptable Dogs
Adoption Policies
Adoption Form
Contact Us
Animal Information
Dog Name
*
Where did you hear about us?
*
Date
*
MM
DD
YYYY
Applicant Information
Name
*
First Name
Last Name
Are you 21 years or older?
*
Yes
No
Phone
*
(###)
###
####
Driver's License #:
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Household Information
*
Own
Rent
Does your lease allow dogs?
Yes
No
Landlord's Name:
Landlord's Phone:
(###)
###
####
House Type:
*
House
Apartment
Duplex
Townhouse
Condo
Other
If you selected "Other", please explain:
Do you have a completely fenced yard?
*
Yes
No
If you selected "Yes", what is the height of the fence?
If you selected "Yes", what is the Approx. size of the fence? ____ x ____
Fence Type:
*
Chain Link
Wood
Other
I do not have a fence
If you selected "Other", please explain:
Please explain how you plan to exercise your foster and how often?
*
How many people live in your household?
*
Ages of children under 18:
Is everyone in your household in favor of fostering/adopting this pet?
*
Yes
No
If you selected "No", please explain:
Your occupation:
*
Current Pets
Please list ALL current pets living in the house:
Must include breed, age, male or female, and if they are fixed.
Are ALL pets currently in your home up to date on vaccinations and licensed in the county in which you reside
Yes
No
History
Have you ever adopted a dog before?
*
Yes
No
Have you ever relinquished an animal to a shelter or given an animal away?
*
Yes
No
What is the name of your regular veterinarian?
*
Phone:
(###)
###
####
City:
State:
Zip Code:
Do we have your permission to contact your regular veterinarian as a reference?
Yes
No
Lifestyle Information
Why are you adopting a dog? Check all that apply:
*
Support animal rescue
Gain more animal rescue experience
Companion for self
Companion for family member
Other:
If you selected "Other" or "Companion for family member", please explain:
On a normal day, how many hours will your dog be alone?
*
  Where will they be during this time?
*
Where will your dog sleep?
*
Will your dog primarily be indoors or outdoors?
*
Indoors
Outdoors
Approximately how many hours will your dog be outside per day?
*
What is the activity level in your home?
*
Low
Medium
High
Describe your training plan for this dog:
*
Under what circumstances would you give up or return an adopted dog?
*
What is your plan if you take vacations, trips, or other extended activities away from home?
*
Review
If FOCCAS deems it necessary, do you agree to participate in a home visit prior to adopting?
*
Yes
No
Have you reviewed the FOCCAS adoption policies?
*
Yes
No
Do you verify that you have reviewed the information provided on this form and that it is correct?
*
Yes
No
Do you want/need additional information on how to train your adopted dog?
*
Yes
No
In the case of a dog that cannot be spayed/neutered for medical reasons or puppies under the age of 12 weeks, you must sign a spay/neuter form. Failure to spay/neuter will result in the adoption being voided and the dog must be returned to FOCCAS. An adoption will not be considered finalized until the adoption contract is fulfilled. Do you agree to this?
*
Yes
No
NA (already spayed/neutered)
FOCCAS strives to place each of our dogs into caring and responsible homes. Your completion of this form does not guarantee that your application will be approved. Dogs are always placed in homes that are compatible with their needs and personalities. Do you understand and agree that FOCCAS has the right to deny any application, for any reason?
*
Yes
No
Is there any other additional information we should know about?
*
For signature, type out full first and last name:
*
Today's Date:
*
MM
DD
YYYY
Thank you!
