Name Street Address Address (cont.) City State/Province Zip/Postal Code DOB Home Phone E-mail Employer Work Phone
Name of the pet you are interested in
Do you live in a:
House Apartment Trailer Condo
Do you:
Own Rent
If you rent, are pets allowed by your rental agreement?
Yes No
If you rent, who is your landlord and what is his/her phone number?
Do any family members have allergies to dogs or cats?
Are all members of your family in favor of adopting a dog or cat?
Do all the members of your household understand that it might take a few days or weeks for a new dog or cat to get accustomed to it.s new home?
Are there any children living in or frequently visiting your home?
If yes, how many and what are their ages?
Are you a first time dog or cat owner?
If no, do you have any pets at home now and if so, please list them all and describe them by breed, gender and age. (Are they spayed and/or neutered?)
If you do not have any pets at home now but have had pets in the past, please list the pets, how long you had them and what were the circumstances that you no longer have them now.
Do you know that dogs/cats need yearly vaccinations?
If your new pet needed to learn the basics, how would you go about the training? (Check all that apply)
Obedience classes Use a book Personal knowledge Other
Would you be able to tolerate a few accidents in the house while your pet adjusts to it.s new home
What kind of solutions would you be willing to try if house-training accidents continue after the first week? (Check all that apply)
Paper training Crate training Use of a dog door Other
What kind of a dog or cat are you looking for?
Male Female No Preference
Age range?
If a puppy, have you ever had a puppy before?
What traits do you want in a dog? (Check all that apply)
Independent Dependent Gentle Rough/feisty Confident Playful Serious/quiet Easygoing
What role would you want your new dog to play in your life? (Check all that apply)
Companion Family Pet Hunting/Breeding Protection Other
Under what circumstances would you return the dog/cat to VFAW?
How long do you plan to provide a home for this dog/cat?
If you had to move somewhere where pets were not allowed what would you do?
Where will the dog or cat live?
Indoors Outdoors Both indoor and outdoor In a kennel In a fenced yard Tied up outside Running free
Do you have a fenced in yard?
If yes, please describe:
If no, how do you plan to contain the dog and how would he/she get their exercise?
How would you classify your home?
Quiet & Calm Moderately Active Very Active
Would your new dog encounter any of these situations or activities? (Check all that apply)
Children playing Teenagers Bicycles Cats (indoors) Cats (outdoors)
Who will be primarily responsible for the care of the dog/cat?
Who will care for the dog/cat when you are out of town?
How many hours a day generally will your dog/cat be without human companionship?
Where will you leave your dog/cat when no one is home?
How long have you been looking for a new pet?
Why do you want a new pet?
The foster care providers for the animals try their best to judge the temperament and behavior of the animals in their care and will disclose all known information to prospective adopters. However, there is no guarantee how the animal will behave in a new home setting. Keeping this in mind, would you be willing to make reasonable measures to assure the success of the adoption? ie: making improvements on a fence if dog escapes, taking dog to obedience classes to improve manners, giving reasonable adjustment time for the new pet, family members and companion pets already in the household?
Signature (Type name)
Date:
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