Dumas German Shepherd Rescue
Adoption Questionnaire
Your Name:
Email:
Address:
City:
State:
Zip:
Phone Number(s):
Cell Phone Number(s):
Animal you are interested in:
Do you currently have animals?
Yes:
No:
Describe the pet(s) you had (have) in the past 10 years and what has happened to them. This is important to the compatibility of the animal you are interested in. Please include ALL types of animals you care for. Please put "N/A" in this space if it does not apply.
(specifics, breeds, age, spay/neutered, training)
Have you ever given up an animal?
Yes:
No:
Describe the Circumstances and the type of pet you gave up: Please put "N/A" in this space if it does not apply.
Veterinarian Reference:
Name:
Address:
City:
State:
Zip:
Phone Number:
Tell us about who is living in your home and include children and ages. (please include step/grand children or any other children that may visit often.)
(This should include step children and grandchildren if they visit on a regular basis)
Rent:
Own:
Landlord's name, if you rent:
Name:
Phone Number:
How long have you been at the current residence?
Please describe the area you live in?
Rural:
Urban:
Other:
Do you have a fenced yard?
(not required for all adoptions)
Yes:
No:
Describe the type, size, and height of your fence. Please put "N/A" in this space if it does not apply.
Where would your new pet be at night?
Please describe.
Where would your pet be at when you are not at home or on vacation?
(This also includes when you are at work)
Please describe.
Why do you want a rescued pet?
Preferred Gender:
Male:
Female:
No Preference:
Preferred Age:
Under a year:
Under 5 years:
Senior:
No Preference:
Describe the "perfect pet" for your situation.
Do you plan to do any training? If yes, describe.
What do you plan to do if a behavior problem occurs?
Would you agree to have a home visit done by a volunteer at your convenience?
Yes:
No:
What situation, do you feel, justifies giving up a pet, and what would you do if you were put in that kind of position ? Please describe.
Is there anything else you would like us to know, or to include, in regards to this form?
Please provide two personal references.
(only one may be a family member)
Name:
Phone Number:
Name:
Phone Number:
Thank you for your interest in saving a homeless animal!!!
This is a preliminary questionnaire only and does not guarantee that a pet will be placed with you. This is only the first step to rescuing one of our special animals.
Falsifying any information will disqualify you from adopting through our organization.
ALL REFERENCES WILL BE CHECKED!