Adoption Information
1) How did you hear about us?
Select One Adopt-a-Pet Petfinder Facebook Internet Search Advertisement in Paper Referral From Someone Else Show/Festival Booth Other
If other, please indicate
2) What do you know about the breed you are interested in adopting (temperament, health, etc)?
3) Why do you want to adopt this dog? Please give all reasons that apply (companion, guard dog, gift, to breed, personal protection, for children, other).
5) Do you rent or own your current home?
Select One Own Rent
4) How long have you lived at the above address?
6) What type of home do you currently live in?
Select One Single Family Home Multy-Family Home Condo Townhouse Apartment Mobile Home
7) If you rent, please provide us with your landlord's name and phone number. Please note that we will contact your landlord.
8) If you move to a location that does not accept dogs, what will you do?
9) If you have children living in your home or that visit on a regular basis, please indicate their name, sex, and age(s).
10) Are there other adults in the household? How many?
11) Do all adults in the house approve of getting a dog?
Select One Yes No
12) How many hours will this pet be alone most days?
13) Have you ever owned a dog of this same breed?
Select One Yes No
14) If you have other animals, please fill out the section below listing, species, breed, age and whether they are spayed or neutered.
15) If you have owned animals in the past, what happened to those pets? (i.e. Put to sleep because of old age or health, ran away or stolen, given away to to a family member, released to animal shelter, given away through newspaper ad?)
16) Do you take your pet to a vet annually?
Select One Yes No
17) Are your current pets current on their vaccinations and heartworm preventative (where applicable)?
Select One N/A Yes No
18) Are you familiar with heartworm preventative and the vaccinations that are necessary?
Select One Yes No
19) We require that all animals adopted from us be spayed/neutered. If you have any questions/concerns/reservations about this policy, please explain below.
20) Are you prepared for the possibility of more than routine vet bills and care of the dog?
Select One Yes No
21) If you have animals in the house that are not spayed/neutered, fully vaccinated, and on heartworm/flea prevention medicine - please explain.
22) Please provide us with the name/address/phone number of your veterinarian. We will call them for a reference.
23) Do you have a fenced yard?
Select One Yes No
24) What kind of fencing do you have?
Select One None 4 Ft. Chain Link 5 Ft. Chain Link 6 Ft. Chain Link 4 Ft. Privacy Fence 6 Ft. Privacy Fence Chain Link/Privacy Combo Invisible Fencing Electric Fence Dog kennel Chicken Wire/Cattle Fence Other
If other, please indicate
25) If you DO NOT have a fence, how will your new dog be exercised and go to the bathroom?
Select One N/A Paper-Train Turn Loose Outside Tie-Out/Runner Leash Walks Other
If other, please specify where
26) Would you allow a home visit by a volunteer on behalf of rescue?
Select One Yes No
27) Where do you plan to keep your new dog the MAJORITY of the time?
Select One Inside Outside Garage Basement Crate/Cage Other
If other, please specify where
28) Where will your new dog sleep at night?
Select One Inside Outside Garage Basement Crate/Cage Other
If other, please specify where
29) What will you do with your new dog when there is no one home?
Select One Inside Outside Garage Basement Crate/Cage Other
If other, please indicate
30) What will you do if your new dog exhibits bad behavior? ie..being destructive, soiling the house, barking, etc.
31) Do you understand that a dog may not be housebroken and are you willing to take the time to properly housetrain?
Select One Yes No May Be
32) Do you understand that it may take this dog time (at least 30 days)to adapt to his new environment and family?
Select One Yes No May Be
34) Would you be willing to adopt a dog with a medical condition (allergies, thyroid problem, etc). Note: We will not adopt out a dog with a major medical problem such as cancer.
Select One Yes No May Be
33) What are your preferences for your adopted dog? ie..age, sex, color, etc.
35) Would you be willing to adopt a dog with a behavior problem (chewing, separation anxiety, fear of thunderstorms, not housebroken, etc.) Note..we will not adopt a dog that is aggressive or has bitten before--under ANY circumstances.
Select One Yes No May Be
36) Did you see a particular dog on our website that you are interested in? If so, please indicate below
37) Please give 2 references, one must be professional.
38) Please write any additional comments below. Use this space to also indicate any health or behavior problems that you could NOT handle or why you think we should consider you for adoption!
