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| Type of animal you are applying for (include pet’s name) |
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| How did you hear about our shelter/this pet? |
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| Please fill out the following questionnaire which will be reviewed by one of our adoption counselors: |
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| 1. What past experiences have you had with a pet(s) |
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| 2. What pets do you currently have in your household? List below: |
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| 3. List pets you have owned in the past five years. Do you still have them? If not, why? |
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| 4. Who is your current Veterinarian? (Name & Phone Number) |
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| 5. Would you be opposed to providing a reference from your veterinarian? |
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| 6. If you are from out of town, would you be opposed with us having another rescue organization or humane society doing a home visit for us? |
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| 7. Do you currently live in a: |
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| 8. Do you own or rent? |
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| 9. If you rent, does your lease allow pets? |
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| 10. If you rent, what is the phone number to the leasing office so that we can verify the specifications they allow? |
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| 11. How long have you lived at the above address? |
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| 12. How many people live in your household? |
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| 13. Do all of the adults in your home know that you are adopting a pet? |
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| 14. Are there any children in your home? |
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| If so what are their ages: |
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| 15. Do you or anyone living in your household have any known pet allergies? |
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| 16. If yes, how severe and what animals are they allergic to? |
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| 17. Who will be responsible for the care of this pet? |
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| 18. Where will this pet be kept during the day? |
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| 19. How many hours will it spend alone without human companionship? |
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| 20. Where will the pet be kept when alone? |
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| For Dog Adoptions Only: |
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| 1. Do you want the dog for a: |
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| 2. Do you have a fenced yard? |
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| 3. How will you keep your dog confined to your property? List all that apply: |
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Other:
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| 4. Are you familiar with house training? |
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| 5. Are you willing to work with your new dog or puppy to train him / her? |
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| 6. Are you familiar with the leash and licensing laws in your community? |
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| 7. What will you do if your dog chews furniture or displays any other destructive behavior? |
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| 8. Are you familiar with crate training? |
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| What is your opinion of this? |
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| 9. Do you plan on taking your dog to obedience training classes? |
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| 10. Are you familiar with heartworm disease & prevention? |
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| For Shelter Use Only – Do Not Write Below This Line. Thanks! |
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