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Dog Pre-Adoption Form
Name of dog you're interested in
Telephone: Home
Telephone: Cell
Telephone: Work *
Your name is *
Your city: state: zip code is *
How long have you lived here? *
Is this a: House, Condo, Townhouse, Duplex, Apartment, Mobile Home *
Do you: Own this dwelling or rent it? *
Do you: Live with roommate? Live with parents? *
Name of apartment complex and landlord's phone # *
(Internal use only) - Proof of pet deposit verified by )
Are you 21 years old? *
Are you: Employed / Unemployed / Retired / Work at Home *
Employed where? How long? *
If you are a stay-at-home mom, please give name of husband's employer and phone #
Why do you want me? *
Does your spouse want me? Yes / No / Not sure / N/A *
Does anyone in your household DISLIKE dogs? Yes No Not sure *
Who will be responsible for my care? *
How many adults live in your home? *
How many children are in your home? *
Does any member of your family have allergies? If yes, to what? *
Does any member of your family have respiratory problems? *
What will you do with me if any member of your family develops allergies or respiratory problems? *
Does anyone in your household smoke? If yes, how much? *
As an ADULT, how many animals have you had? Where are they now? *
Which of your other pets live indoors? Which live outdoors? *
Are all your other pets spayed or neutered?
Are all your other pets up to date on vaccinations? May we verifty this with your veterinarian? *
Who will be my veterinarian? ( Please give name, clinic name, and phone number ) *
Will I have a fenced yard to play in? *
What behaviors will you NOT tolerate? *
Are you willing to, and do you have the time to dedicate to correcting these behaviors?
Can you afford to take me to obedience school? *
How long will I be alone during the day? *
Where will I stay during that time? *
Have you ever given away an animal? If yes, please explain. *
Please list which of the following reasons you would give an animal away: allergies, moving, parents moving in with you, having a baby, divorce, loss of job, going back to work, no time for the dog, retiring, agression, barking, chewing, digging, not housebroken, *
In your own words, what does "Lifetime Committment" mean to you? *
Your stree address is (no P.O.Boxes): *

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