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Dog Adoption Application
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* Indicates required question
Name:
*
Your answer
Address:
*
Your answer
Town/City/Postal Code:
*
Your answer
Home Phone:
*
Your answer
Cell Phone:
Your answer
Email:
*
Your answer
Age Range:
Choose
Under 20
20 - 30
30 - 40
40 - 50
50 - 60
60 - 70
Over 70
Occupation:
Your answer
Household Income:
*
Choose
Under 20K
$20K - $40K
$40K - $60K
$60K - $80K
Over $80K
Name of dog you are interested in adopting:
Your answer
Why have you chosen this particular dog?
Your answer
Please explain what you are looking for in a dog.
Your answer
Are you adopting this dog for you or for someone else? (If for someone else, who?)
Your answer
What experience do you have as a dog caregiver? Please tell us about dogs you have lived with.
Your answer
Do you currently live with any pets?
Yes
No
Clear selection
If yes, what type of pets?
Your answer
Are your pets spayed/neutered?
Yes
No
Clear selection
Do you live in a house, apartment, condominium or townhouse?
Please check 1
House
Apartment
Condo
Townhouse
Please check 1
House
Apartment
Condo
Townhouse
Do you own or rent your home?
Rent
Own
How long have you lived at your current address?
Your answer
Do you have children? If so, please list their ages.
Your answer
Is any member of your family allergic to dogs?
Yes
No
Clear selection
List all members of your household.
Your answer
Does everyone agree to adopting a dog?
Yes
No
Clear selection
Who will be primarily responsible for the care of this dog?
Your answer
Who is your veterinarian?
Your answer
May we contact them as your reference?
Yes
No
Clear selection
What is your veterinarian’s phone number?
Your answer
Do you have dog training experience?
Your answer
What canine behaviour would you find totally unacceptable?
Your answer
What canine behaviours or traits are you looking for in an adoptive dog?
Please select all that apply
House trained
Good with other cats
Good with other dogs
Good with children
Other
Please select all that apply
House trained
Good with other cats
Good with other dogs
Good with children
Other
If you answered other above, please explain
Your answer
Describe your method of disciplining a dog. You have just come into the kitchen to find the garbage has been knocked over. How do you respond?
Your answer
You have come home to find your dog has pooped in the house. What do you do?
Your answer
Are you willing to seek guidance/attend classes with your adopted dog, should you experience behavioural challenges?
Yes
No
Clear selection
What type of training/ classes would you choose?
Your answer
Where will your dog primarily live?
Please select one
Inside
Outside
Both
Please select one
Inside
Outside
Both
Where will the dog be kept primarily?
Please select one
House
Yard
Garage
Other
Please select one
House
Yard
Garage
Other
How many hours of the day will the dog be alone?
Your answer
Will the dog have access to the whole house?
Yes
No
Clear selection
Where will the dog be sleeping?
Your answer
Do you have a yard?
Yes
No
Clear selection
If yes, is the yard fenced?
Yes
No
Clear selection
Do you have a pool?
Yes
No
Clear selection
If yes, is there a fence around it?
Yes
No
Clear selection
Describe the exercise that you have in mind for your adopted dog?
Your answer
What type of food will you be feeding your adopted dog?
Select all that apply
Wet
Dry
Select all that apply
Wet
Dry
List the brands of food here:
Your answer
How will your dog be cared for if you have to be away from home for an extended period of time on vacation or for business?
Your answer
Check any of the following reasons why you would give your dog away
Please choose all that apply
Fleas
Getting married or divorced
Allergies
Chews or destroys objects
Too Expensive
Children no longer care for it
Having a baby
Moving where no pets allowed
Other
Please choose all that apply
Fleas
Getting married or divorced
Allergies
Chews or destroys objects
Too Expensive
Children no longer care for it
Having a baby
Moving where no pets allowed
Other
If you answered other above, please explain:
Your answer
Approximately how much do you think a dog will cost per year?
Your answer
Do you know the cost of veterinary emergencies?
Yes
No
Clear selection
If your dog ran out the door and was hit by a car. The veterinarian can repair the broken leg (and the dog would recover) at a cost of $2500.00 what would you do?
Your answer
What are your thoughts on Pet Insurance?
Your answer
Would you have an objection to meeting someone from our agency via Zoom, Skype or FaceTime to conduct a home check prior to the adoption of a dog?
Yes
No
Clear selection
Are you aware that there is an adoption fee of $600.00?
Yes
No
Clear selection
The adoption fee may include a veterinary exam, spay/neuter, age appropriate vaccines, and a microchip implant. Many of our rescued dogs also have full blood panels run, dental surgeries and other necessary procedures as per their specific needs
Thank you for your time and effort completing the pre adoption questionnaire. One of our volunteers will be in touch shortly by telephone to speak with you about adoption.
If however, we feel the dog you have chosen is not a good match we will reply via email with an explanation; we may suggest considering a different dog.
Thank you!
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