JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Telephone Reference Check
Form used to verify Adopter's references.
Sign in to Google
to save your progress.
Learn more
Applicant and Reference Information
Your answer
Adopter's Name:
Your answer
Reference Name
Your answer
Reference Address:
Your answer
Reference Telephone Number:
Your answer
How long have you known the Applicant:
Your answer
How do you know them?
Your answer
What animals does the Applicant have now?
Your answer
Describe interactions that you have seen between your friends and their or other people's animals.
Your answer
Where are these animals now? (If not present in home)
Your answer
Have they ever had any pets hit by a car or with a serious disease or injury? What were the circumstances and did they receive Veterinary care?
Your answer
How will others in the home feel about a new dog? Spouse, kids, parents, etc?
Your answer
Do the animals have free run of the secure yard when no one is home?
Yes
No
Clear selection
Is there a doggy door?
Yes
No
Clear selection
Do you have any concerns with them adopting another animal?
Yes
No
Maybe
Clear selection
If you left this life and returned as a pet, would you want them to own you?
Yes
No
Clear selection
Status of this Reference:
Approved
Disapproved
Clear selection
By typing my name, I attest that I have completed this reference and based upon our conversation, believe that the adopter above should continue based upon the status above.
Your answer
Date:
MM
/
DD
/
YYYY
Time:
Time
:
AM
PM
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report
