Adoption Questionnaire

Phone

Landlord Name and Phone number

City/State/Zipcode

Do you

Own

Rent

Live with parents

Other

What method will you use to housebreak your dog?

Address

Do you understand that annual veterinarian costs can be between $100-$500 and possibly more for health problems or emergencies? Are you prepared for this?

Yes

No

Name:

Previous Pets

Dog

Cat

Other

If you have pets please list type/breed, age, indoor/outdoor, and how long you've had them

Phone

Do you have a securely fenced yard? List fence type and height for front and back yards.

Personal reference and relationship

Home Phone

If you rent, does your landlord allow pets?

Yes

No

My dog(s) are

Spayed/Neutered

Current on vaccinations

Obedience trained

How will you exercise your dog?

Is there a pet deposit?

Yes

No

Are there restrictions? (Size/weight, number of pets, type)

Where did you find out about this pet?

Animal you are interested in

Who will be responsible for daily care?

Birth Date

List previous pets, how long you had them, and why they are no longer with you.

I certify that all statements are true and complete. I understand that any false statement is cause for refusal of adoption or reclaiming of adopted pet.

Where will the dog be when you are gone?

***For CATS Will the cat be

Indoors

Outdoors

Indoor/outdoor

List people in your house including children and their ages

Your place of employment. How long?

Cell Phone

How many hours will the pet be alone daily?

Where will the litterbox be kept?

My cat(s) are

Spayed/Neutered

Declawed

Current on vaccinations

Work Phone

Will the dog ever be allowed to ride in the back of a truck? If yes explain.

What are your views on declawing?

How long have you lived there?

Who is your veterinarian?

Email

Name of nearest relative and relationship

***For DOGS Where will the dog be when you are home?

Do you have any concerns/questions about the pet you are interested in adopting?

Do you currently have pets?

Dog

Cat

Other

None