Adoption Questionnaire

How many hours will the pet be alone daily?

Why do you want to adopt a pet? Check all that apply

Companion for myself

Companion for child

Personal protection

Companion for other pet

Barn cat/mouser

Other

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

Where did you find out about this pet?

Animal you are interested in

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.

Phone

Landlord Name and Phone number

City/State/Zipcode

Do you

Own

Rent

Live with parents

Other

Who will be responsible for daily care?

Birth Date

What are your views on declawing?

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.

How long have you lived there?

Who is your veterinarian?

Where will the dog be when you are gone?

***For CATS Will the cat be

Indoors

Outdoors

Indoor/outdoor

Email

Name of nearest relative and relationship

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

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:

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

List people in your house including children and their ages

Your place of employment. How long?

Do you currently have pets?

Dog

Cat

Other

None

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.

Cell Phone

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