Dog Adoption Form
First Name
Last Name
Spouses Name
Street Address
City
State
Zip
Home Phone Number (numbers only)
Cell Phone Number (numbers only)
email address
Occupation
Employer
Spouses Occupation
Spouses Employer
name/age/relationship of all residents
Do you own a home
own a home
rent a house or apt.
live with parents
other
Is your home
single family house
two family house
apartment
townhouse/condo
other
do you have a fenced yard
yes
no
height of fence
does your lease or complex allow pets
yes
no
unsure
landlord's name
landlord's phone number
Anyone have allergies/breathing issues
yes
no
Is this your first dog
yes
no - I grew up with dogs
no - I have owned dogs
who is this dog being adopted for
myself
family
kids
parents
a friend
a gift
do all family members want the dog
yes
not exactly
no
is entire family aware of the adoption
yes
not exactly
no
it is a surprise
who will be dog's primarily caretaker
myself
family
kids
parents
a friend/neighbor
will you spay or neuter the dog
yes
no
How many dogs in home currently
Names of current dogs
How many cats in home currently
Names of current cats
Current pet 1 breed
Current pet 1 age
Current pet 1 sex
male
female
Current pet 1 spayed/neutered
yes
no
Current pet 1 temperament
Current pet 1 from
breeder
shelter
store
Current pet 1 years owned
Current pet 1 shots status
up to date
not up to date
Current pet 2 age
Current pet 2 breed
Current pet 2 spayed/neutered
yes
no
Current pet 2 sex
male
female
Current pet 2 temperament
Current pet 2 from
breeder
shelter
store
Current pet 2 current with shots
yes
no
Current pet 2 years owned
vet used for pets above
vet's phone number
past pet 1 breed
past pet 1 age
past pet 1 sex
male
female
past pet 1 spayed/neutered
yes
no
past pet 1 from
breeder
shelter
store
past pet 1 years owned
past pet 1 current with shots
yes
no
What happened to pet
died
given away
with relative
hit by car
ran away
past pet 2 breed
past pet 2 age
past pet 2 sex
male
female
past pet 2 spayed/neutered
yes
no
past pet 2 from
breeder
shelter
store
past pet 2 years owned
past pet 2 current with shots
yes
no
past pet 3 breed
past pet 3 age
past pet 3 sex
male
female
past pet 3 spayed/neutered
yes
no
past pet 3 from
breeder
shelter
store
past pet 3 years owned
past pet 3 current with shots
yes
no
prev. vet name,address,phone #
may we contact your vets
yes
no
Ever surrender/give a way a pet
yes
no
reason for surrender
ideal pet traits (select all applicable)
house pet
outside pet
pet for breeding
companion
watch dog
gift ( fill out next question)
gift for who
desired breeds
desired sex
male
female
does not matter
age range
adult - over 12 months
puppy 2-4 months
4-8 months
8-12 months
senior
size
toy 3-10 pounds
small 5-20 pounds
medium 20-50 pounds
large 50-80 pounds
x-large 80+ pounds
Select all desired pet qualities
housebroken
obedience trained
non-shedding
calm
energetic & liks to play
smart
outgoing
lap dog
dog friendly
cat friendly
child friendly
where will you exercise you dog/puppy
my yard
neighborhood
dog park
other
when will you exercise your puppy
morning
mid day
evening
how long will the dog be alone
how will you keep the dog during the day
family room
basement
kitchen/bath
yard
relative/neighbor
crate
loose
with me
how will you keep the dog at night
family room
basement
kitchen/bath
yard
relative/neighbor
crate
loose
with me
when left alone
family room
kitchen/bath
basement
yard
relative/neighbor
crate
loose
do you work
no
yes
part time (fill out question below)
how many part time hrs/week
do your housemate(s) work
no
yes
part time (fill out question below)
how many part time hrs/week
who walks dog if alone more than 8 hrs
dog walker
friend
neighbor
home at lunch
bring to work
opposite shifts
other
how handle dog adjusting to new home
time frame for new dog to adjust
1 week
1 month
1 year
as long as it takes
would you attend obedience classes
yes
no
maybe
when was you last dog/puppy training
within last 5 yrs
within last 6-10 years
as a teen
parents did it for me
never; I am new at this
which issues would cause return
barking
house training
chewing
digging
fear of men
fear of women
dominance
aggression
separation anxiety
possessiveness
under socialization issues
fear of or indifference of children
other destructive behavior
how will you reprimand your dog
will you get trainer for bad behavior
yes
maybe
no - I would return dog
aware of $50-200/session training costs
yes
no
What would cause to return
moving
biting
kids lose interest
training
housebreaking
allergies
can we make pre and post adoption visits
yes
no
i understand and agree to all the above
yes
no