Pre-Adoption DOG Questionnaire

This purpose of this form is to evaluate candidates wishing to adopt a pet, and to find the best possible match ...

Which Canine(s) are you interested in?

About yourself:

Last name:		First name:
Address:		City:
State:	Zip/Postal	Home Phone:
		Work Phone:
Email:		DL#

1. What is your primary reason for adopting a dog?
A companion for: you; housemate ; your children; other pet;
A gift; Other:

2. Who shares your household?
Spouse; Significant Other; Roommate; No one;
Children (ages ); Other

3. Are all members of the household aware and in agreement to owning a dog? Yes; No.

4. Type of dwelling: House; Apt.; Condo.; Other

5. Are you permitted to have dogs where you live? Yes; No; Don't know.

6. About how many hours will the dog be left alone each day?

7. Who will be responsible for the care of the dog?

8. Where will the dog sleep: Indoors ; Outdoors.

9. Do you have a fenced in yard? Yes; No. How high

10. Does your fenced in yard have lockable gates? Yes; No

11. If you currently have pets, are they spayed and neutered? Yes; No; Not applicable.

12. How will you discipline the dog for misbehaving?
Use newspaper; Spank; Swat nose; Stern voice; Squirt with water;
Other

13. How long do you plan to keep the dog you wish to adopt?

14. What do you think the normal life span of a dog is?

15. Do you consider a dog; a pet; a member of the family; both?

16. Under what circumstances might you not keep the dog? Shedding; Move;
New housemate; New baby; Not House trained; Allergies; Separation Anxiety; None of the Above; Other

17. Do you plan to feed your dog: Canned food only; Dry food only; Both.

18. Do you plan to buy: Grocery store brands; Pet store brands; Both.
Which brand(s) do you plan to feed the dog that you adopt?

19. Do you have a vet? Yes; No; Name:

20. Are you willing and able to provide quality medical care;
(i.e. yearly vaccinations, treatment for illness or injury)? Yes; No.

21. Have you ever had a dog? Yes; No .

22. If Yes, what happened to the dog?

23. Do you have other pets now? Cat; Dog; Bird; Other

24. Would you object to a home visit by one of our volunteers? Yes; No .