DOG ADOPTION QUESTIONNAIRE

Tell us a little about yourself:

First Name*
Last Name*
Email*
Home Phone*
Work Phone
Your Address*
Your Address 2
City*
State*
Zip*
How many adults are in your home?
How many children?
Children Ages:
Please list any step-children, grandchildren and others, including their ages, that visit on a regular basis such as weekends or vacations.
Do you live in a HouseTown Home/CondoDuplexMobile HomeApartmentOther
If you rent, do you have your landlord's permission to have a cat/dog?YesNo
Landlord's Name Phone
How large is your yard?
Is it fenced?YesNo
If yes, what type and how high?
Do you object to a home visit prior to your adoption?YesNo
Do you object to follow up visits?YesNo
Do all family members want a cat/dog?YesNo
Is anyone in the household allergic to cats/dogs?YesNo
Who will be primarily responsible for the dog’s care?
Who will be financially responsible for the dog?
Pets that are well cared for often live 10-15 years or more. Are you prepared to accept responsibility for this dog for the rest of his/her lifetime? YesNo
How long would the dog be alone each day?
Where will the dog be kept during the day?
Where will the dog sleep at night?
Have you previously housetrained a dog?YesNo
How would you discipline a dog that had an accident on the carpet?
How would you handle a dog that chewed or showed destructive behavior?
What types of dog behavior do you find difficult to deal with?
What other pets currently live in your household? (type, sex, age)
All pets in my household are spayed/neutered and current on all vaccinations and dogs are on heart-worm preventative medicine. (If you do not have dogs currently, are you familiar with heartworm disease and how it is prevented?)YesNo
Where are current pets kept?
Have you owned any other pets within the past 10 years other than those listed above? If yes, please list name, breed, and sex of each and explain what happened to them and the circumstances. (i.e. died from _________, gave away because ___________, etc.)
Where did you get your past and current pets?
Are you willing to attend obedience classes with your dog?YesNo
How do you plan on making sure your dog gets enough exercise?
What other activities will you involve your dog in?
How would you transport this cat/dog if you took him/her places with you?
What characteristics do you expect in your new dog? (check all that apply)ActivePlayfulIndependentLovingOutgoing/FriendlyGentleProtectiveDominantShy/DocileAggressiveGood with other petsEasy to trainGood with kidsCalmIntelligentSubmissiveOther
What is a reasonable amount of time to allow a new dog to adjust to your home?
What do you consider a valid reason for giving up a dog? (NOTE: DHS must always be contacted in the event that a dog adopted from us needs to be rehomed.)
Please add anything else you would like and feel free to ask any questions!