Dog Adoption Application

List members of your household and any other children or significant people your dog will interact with: .... Yellow pages or other advertising. □ Radio or TV. □ Other. □ Add me to the HSHV email list for the latest news updates, adoption ...
44KB Sizes 4 Downloads 128 Views
Home Phone _________________ Work Phone _________________ Cell Phone ________________ Email ______________________________

Address ___________________________________________ City _______________________________ State ________ Zip ________________

Last Name ____________________________________ First Name ______________________________ Date of Birth ______________________

DOG ADOPTER SURVEY

Date _____________

- - - - Office use only - - -  Dog Interaction Consult Fee Paid

1

Do you:

 Own

 Rent

 Live with Parents

 Other ________________________________

If renting, Landlord Name _________________________________ Phone# _____________________________  House

 Apartment

2

Residence Type:

3

Yard/Outside Area Type:  Open Yard

4

The noise/activity level in my home is usually:

 Condo/Duplex

 Fenced Yard

 Mobile Home

 Dog Run

 Low

 Tie Out

 Medium

 Invisible Fence

 High

List members of your household and any other children or significant people your dog will interact with: Name

5

6

7

Adult (Y/N) or Child’s Age

Lives in Household (Y/N)

If No, Relationship or Anticipated Interaction

______________

____________ _______________

___________________________________________

______________

____________ _______________

___________________________________________

______________

____________ _______________

___________________________________________

______________

____________ _______________

___________________________________________

 NO

Is anyone in your family allergic to dogs? I am adopting this dog/puppy for:  Myself  Companion of other animal

 YES, who: ______________________________

 My Children

 Guard dog

 My Family

 Hunting dog

 A Friend

 A Relative

 Other ______________________

8

The dog’s primary caregiver will be: ______________________________________________________________

10

Have you ever owned a dog before?

11

The last time I had a dog was:

 Yes

 No

 Within the last year

 Grew up with or had as family pet

 2-5 years ago

 More than 5 years ago

List any pets owned, alive or deceased, in the last 5 years and any other animals a new pet would need to get along with: Name

12

Species/Breed

Age

Sex

Sterilized (Y/N)

Deceased Indoor/Outdoor

(Y/N)

If No, where living now?

_______________ ___________ _____ ____ _______ ___________ _____ - _____________________ _______________ ___________ _____ ____ _______ ___________ _____ - _____________________ _______________ ___________ _____ ____ _______ ___________ _____ - _____________________ _______________ ___________ _____ ____ _______ ___________ _____ - _____________________

13

14

List your veterinarian’s name, phone number and city:

How long ago did your current animals last see the vet?  Less than 6 months

 6 months to 1 year

 1 to 3 years

 3 to 5 years

15

I’m interested in a dog aged:  Under 6 months

16

My dog will primarily live:

17

How many hours will your dog spend outside


66 Views