Information About Your Home and Family

Please list all persons living with you or visiting often (age and relationship).
For your peace of mind, you need only list ages of children and need not include their names.

Does anyone in the household have any animal allergies? YES  NO

Type of residence: House Condo Apartment Mobile Home

Do you Own Rent Live With Parents

Landlord Name & Phone Number, if applicable

Length of time at this address: 

Is your yard fenced?  YES  NO
If YES- What is the height of the fence and with what material is it made? 

Vet Reference

Who is your local veterinarian? 
Vet's Complete Address 
Vet Phone Number (including area code)
Vet records are under the name of

Are your pets current on all vaccinations?   YES  NO

Matching You With The Right Dog

Briefly describe your past pet experience.

Have you ever had to give up a pet?  (For example: Had to give away or take to a shelter) Please explain why and when.

Please list all companion animals currently living in your household (name, age, type of pet, length of time owned:

Where are these animals kept during the day and at night? (Inside, outside, or both) and how do they get along with other animals?

Your Ideal New Family Member

Please take the time to tell us what personality traits you are looking for in a new dog. Even if you are applying to adopt a specific dog, please provide us with a "wish List" of the characteristics describing the perfect dog for you.

Breed Type or Mix of Breed Types

Size When Full Grown:  Small (1-20 lbs)   Medium (20-50lbs)  Large (50-100 lbs)   Giant (Over 100 lbs)

Gender preference? Male  Female  Either

Coat preference? Short Coat  Medium Length Coat  Long Coat   No Preference

What age range would you like to adopt? 8-16 weeks 4 - 12 months 1-3 yrs Older than 3 yrs Any Age

Activity level of your ideal dog:  Low   Medium   High   No Preference

Where will your new dog be kept during the day? 

And at night? 

How long would the dog be left alone and how will it be kept safe?

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How did you hear about the dog you are applying to adopt?

Would you consider volunteering for our organization  Yes  Not At This Time
If yes, which of the following areas interest you?
Foster Care   Personal interviewing of adoption candidates   Fundraising   Home Visits
Transporting   Computer Assistance  Telephone calling  Representing us at an Adoption Event
Photography Media Liaison Other  PLEASE SPECIFY  

Our Adoption Process

Our adoption process includes signing an Adoption Agreement, in addition to completing this questionnaire. We check Vet references and conduct home visits. Although we do not require [but prefer] the dogs to be kept inside, we do require a fenced area for outside play. These requirements help us to find the the best home possible for our dogs, making sure they do not return to the streets or shelters.

We appreciate your understanding that our primary concern is what is best for our adoptable dogs.

The adoption donation amount is $125.00 and up, which is used to cover a portion of veterinary expenses for the dogs in our care.  Frequently medical expenses amount to more than this for each animal.  Extra donations are greatly appreciated!

We welcome out of state adoptions, providing that the adopters cover transportation costs.  We may also be able to find space on a volunteer transport for out of state adoptions, assuming all previously stated contractual requirements have been met including a home visit and check of vet references.

All the above statements are true to the best of my knowledge. I have read and understand all portions of this document.
YES  NO

Thank you for taking the time to complete this questionnaire.  Again, Dogs 2nd Chance Rescue has only the best interest of the dog's in mind and sincerely wants to adopt the right dog in our program to the right family. Are there any other comments you'd like for us to consider when reviewing your application?  

Comments:

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