Dog Adoption Application
Sign in to Google to save your progress. Learn more
Name: *
Address: *
Town/City/Postal Code: *
Home Phone: *
Cell Phone:
Email: *
Age Range:
Household Income: *
Name of dog you are interested in adopting:
Why have you chosen this particular dog?
Please explain what you are looking for in a dog.
Are you adopting this dog for you or for someone else? (If for someone else, who?)
What experience do you have as a dog caregiver?  Please tell us about dogs you have lived with.
Do you currently live with any pets?
Clear selection
If yes, what type of pets?
Are your pets spayed/neutered?
Clear selection
Do you live in a house, apartment, condominium or townhouse?
Please check 1
Do you own or rent your home?
How long have you lived at your current address?
Do you have children? If so, please list their ages.
Is any member of your family allergic to dogs?
Clear selection
List all members of your household.
Does everyone agree to adopting a dog?
Clear selection
Who will be primarily responsible for the care of this dog?
Who is your veterinarian?
May we contact them as your reference?
Clear selection
What is your veterinarian’s phone number?
Do you have dog training experience?
What canine behaviour would you find totally unacceptable?
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
If you answered other above, please explain
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?
You have come home to find your dog has pooped in the house. What do you do?
Are you willing to seek guidance/attend classes with your adopted dog, should you experience behavioural challenges?
Clear selection
What type of training/ classes would you choose?
Where will your dog primarily live?
Please select one
Where will the dog be kept primarily?
Please select one
How many hours of the day will the dog be alone?
Will the dog have access to the whole house?
Clear selection
Where will the dog be sleeping?
Do you have a yard?
Clear selection
If yes, is the yard fenced?
Clear selection
Do you have a pool?  
Clear selection
If yes, is there a fence around it?
Clear selection
Describe the exercise that you have in mind for your adopted dog?
What type of food will you be feeding your adopted dog?
Select all that apply
List the brands of food here:
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?
Check any of the following reasons why you would give your dog away
Please choose all that apply
Getting married or divorced
Chews or destroys objects
Too Expensive
Children no longer care for it
Having a baby
Moving where no pets allowed
If you answered other above, please explain:
Approximately how much do you think a dog will cost per year?
Do you know the cost of veterinary emergencies?
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?
What are your thoughts on Pet Insurance?
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?
Clear selection
Are you aware that there is an adoption fee of $400.00?
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!

Clear form
Never submit passwords through Google Forms.
This form was created inside of Shelly Hawley-Yan. Report Abuse