Pet Adoption Questionnaire

Pet Information:

Name of Pet:____________________________________________

Canine: Feline: Other: Breed: ____________________

Estimated Age:________ Spay/Neutered: Yes No

Vaccinations: Yes No Felines: Canines:
Leukemia Distemper Rabies DHLP-Par
FVRCP Corona
FIP Bordatella
Deworm
Rabies

Applicant Information:

Name:______________________________________________________

Address: ____________________________________________________Home Phone:___________________

City: _________________________________State:_____ ZIP:_________Work Phone: ___________________

Driver’s License:_____________________State:____________ Car License:____________________________

1. Do you live in a House: Condo: Apartment: Other: (Please Specify)___________________

2. How long have you lived there? _________________

3. Do you rent? Yes   No
If yes, do you have permission from your landlord to have a pet? Yes  No
May we contact you landlord? Yes  No   Name: ______________________________________

Phone: ______________________________________

4. Are you aware that pets need regular vaccinations and may require routine veterinary care? Yes  No

5. Are you willing to provide adequate veterinary care if this animal becomes sick or injured? Yes  No

6. Name of veterinarian: ____________________________________________ Phone: _________________

7. Would you object to an inspection of your premises by our personnel? Yes  No

8. Do you plan to put an I.D. tag on this pet? Yes  No

9. Do you plan to spay/neuter this pet? Yes  No
If not, please explain why ______________________________________________________________

10. How many hours per day will the pet be left alone? ____________________________

Where will the pet be kept during this time? ______________________________

Will the pet be kept: Indoors Outdoors Both

11. Is anyone in your home allergic to animals? Yes  No   Don’t Know

12. What other pets do you currently own? # of dogs:_______ # of cats:__________

# of others (please specify) __________

Please furnish breeds, sex and ages of all pets: ________________________________

________________________________

13. Please list the ages of children in the home. __________________

14. On the first night in the home, where will the pet stay? (please specify) __________________

15. Who will be responsible for the pet? ________________________________________________________

16. Have you ever owned a pet before? Yes  No

If yes, what happened to the pet? _______________________________________________________

If deceased, please state cause if know, and how long ago? __________________________________

17. Pets have been know to chew/claw furniture, carpets and drapes and dig in the potted plants, etc. – how do

plan to deal with this problem? ____________________________________________________________

_____________________________________________________________________________________

18. If you are adopting a dog, are you planning to take it to an obedience class in your area? Yes  No

19. How soon after the pet arrives in your home will it be left alone? __________________________________

20. How often do you travel? ______________________________

How will the pet be cared for when you are out of town? ______________________________________

21. What will happen to the pet if you move (locally)? _______________________________________________

Out of state? ________________________________________________________________________

Overseas? _________________________________________________________________________

22. Under what circumstances would you not keep the pet?

Divorce  Move   New Baby   New   Job   Illness

Other (please explain) __________________________________________________________________