Pet ownership is a serious responsibility.  This policy of the adoption group is to assure that each person who adopts a pet is aware of the responsibility, and that each is capable and willing to accept that responsibility morally, physically, and financially.

It is quite true that not everyone who desires to own a pet should have a pet.
 
The following questionnaire has been designed to aid both you and the adoption group in deciding if you and/or your family is indeed at this moment adequately prepared to assume the type of responsible ownership which we are endeavoring to assure for our adoption animals.

 Please be sure to answer all questions and feel free to add your own comments.  If a question does not apply, write N/A.
 

Adopter Information

 
First Name:
Last Name:
Age:
 
Phone: (Day)
Phone: (Eve)  
Email:
 
 Name of spouse/significant other/roommate:
 
Address:
City:  State:  Zip: 

Occupation:  
 
 Do all adults in your household know you plan to adopt?  
Yes  
No

Who will be primarily responsible for the pets care?
 
What are your reasons for adopting a pet?  

A companion for you  
Your dog    
Spouse  
Children  
Other: (Please Explain)

 

 Your type of Dwelling:

House   
Apartment  
Condo   
Own or Rent? .
 

If you rent, are pets allowed?
Yes  
No  

Length of residency .

Landlord's information:
Name:  
Phone:  
Email:
 
This dog will be:

Indoor only  
Mostly Indoor   
Mostly Outside  
Outdoor only
Other . 
 
If you answered indoor only, please describe what outdoor access the pet will have  (when will it go out, etc.)

 
 If you have children, please list their ages:

Name 1:     Age:
Name 2:     Age:
Name 3:     Age:

Have your children ever been around cats/dogs? 
Yes  
No
 
Has a cat/dog ever bit your child?
Yes  
No
 
Do your current pets like cats/dogs? 
Yes  
No
 
Have you ever bred a cat/dog?
Yes  
No
 
If yes, did you breed for:
Fun   
Show   
Profit   
Accidentally happened
 
 If you presently own a dog has it been neutered/spayed?  
Yes  
No
 If not why?
 
 

Has your cat/dog been vaccinated?
Yes  
No
If so, date of the last vaccine?
Heartworm treatment?
 
 
Past Pet History

Pet Name:  
Breed    
Age 

Spayed/Neutered?
Yes  
No

Do you still have this pet?
Yes  
No  
If not, why?
  

Pet 2 Name:
Breed    
Age 

Spayed/Neutered?
Yes  
No

Do you still have this pet?
Yes  
No  
If not, why?   

Pet 3 Name
Breed    
Age 

Spayed/Neutered?
Yes  
No

Do you still have this pet?
Yes  
No  
If not, why?   

In regards to the above questions, what happened to your pet(s)?

Hit by car   
Old Age   
Died of disease   
Gave Away
Gave to a shelter
(Why?)

  
 What outside space is available for the dog?  Fenced yard  
Yes   Height
No   
 
Type of Fencing:
Chain Link  
Block Wall  
Wood  
Other

Locks on gates? 
Yes  
No

Other provided living areas: 
Garage   
Balcony  
Unfenced yard   
Kennel Run   
Other   .
 
Do you have a: 

Balcony
Pet door  
Unscreened Windows

Do you also have a:    

Pool  -  If so,is it fenced? Yes  No

 
Will you have your dog tied up?
Yes  
No

  Where will your pet sleep during the night? 

  
 In what areas of the house will the dog be allowed? 

 
 How many hours per day on average will the pet be left alone?
 
0-4  
4-6  
6-8   
8-10  
10-12
over 12
  

Veterinarian Info:

Who is your current/last veterinarian?

Name:
Address:
City:  State:  Zip:
Phone:  

Personal References: (please list 2)

Reference 1

Name:
Address:
City:  State:  Zip:
Phone:  

Reference 2

Name:
Address:
City:  State:  Zip:
Phone:  

Additional Info:
 
Will your dog be allowed on the furniture? 
Yes  
No
 If not, how will you train your dog not to jump on your furniture? 

  
How do you plan on housebreaking your new dog?
 
 
Are there any reasons that might preclude you from being able to properly care for your new pet?
If so, please list reasons:
 
 

Under what conditions would you not keep your new pet?
 
Move to a place that didn't allow pets  
Move out of state  
Too much hair
Grew to big
Chewing  
Housebreaking problem
Kids ignored pet
New baby  
Allergy  
Pets didn't get along  
Other (Please explain) 

 

What would you do with your dog if you could not keep it for the above reasons?

 

Do you travel a great deal? 
Yes  
No

Where does your pet stay when you are on vacation?

 
Have you ever trained a dog in obedience class?  
Yes  
No
 
Will you be able to live with fur on your furniture, stains on your rugs, a warm body on your bed, and an animal who may be destructive at times?  Yes  
No
 
 If the dog becomes destructive, what would you do?
 
 
 How did you hear about this pet adoption?

 
Adoptions also require a home inspection by an approved Pet-Angels-Rescue member. 
Will you agree to a home visit with one of our members?
Yes  
No
 

Additional Comments:

  All dogs are required to be spayed/neutered prior to adoption.

 Signature:      Date: