Adoption Questionnaire - Canine

Adoption - Canine

Date
Date Format: MM slash DD slash YYYY
Please list the name of the dog you are interested in adopting.*
Your Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How long have you been at this address?
Daytime Phone*
Evening Phone
What is the best time to call?
Email*
Emergency Contact (Full Name)
First Last
Occupation
Family & Housing
How many adults are in your household (and their relationship to you)?
How many children are in the household (ages)?*
What type of home do you live in?*
What type of fencing do you have (and how tall)?
Please describe your household
Do you rent your home?
If you rent your home, please give the rules governing pets as well as provide your landlord's name and number
By providing this information, you are allowing POPP to contact your landlord. Please inform them of this so they will speak to us when we call.
Does anyone in the family have an allergy to dogs?*
Is everyone in agreement with the decision to adopt a dog?
Do you have time to provide adequate love, attention and training?
Other Pets
What other pets do you have (specify type and number)?
Are these pets up to date on vaccines? If not, why?
Are these pets spayed/neutered? If not, why?
Have you ever rehomed a pet? If yes, why?
Have you ever euthanized a pet? If yes, why?
Have you ever lost a pet due to an accident? If yes, please explain.
How do you discipline your pets? What behaviors do you believe require discipline?
Veterinarian
Do you have a family veterinarian?
What is the veterinarian's name, clinic name, address and phone number?
By providing this information, you are allowing POPP to call your veterinarian. Please call your vet and authorize them to release the information to POPP.
The Dog You Wish to Adopt
What is your idea of an ideal companion dog and why?
Desired age
Desired size
Desired breed
What breed would you not adopt?
Prefered gender
I am willing to adopt a dog that:
Where will the dog spend the day?*
Where will the dog spend the night?
Number of hours (average) the dog will spend alone?
When I'm not at home, my dog will spend his / her time...*
Who will have primary responsibility for this dog's daily care?
Who will have financial responsibility for this dog?
What will happen to this dog if you move?*
Do you agree to provide regular health care by a licensed veterinarian?
Do you agree to keep this dog as a indoor companion?
When the dog goes outside, how do you plan to keep it safe?
If you are no longer able to keep this dog, do you agree to contact POPP?
A home check is required to ensure the safety and well-being of POPP's dogs prior to approval of adoption. Are you willing to allow a representative of POPP to visit your home by appointment?
How did you hear about POPP?
Are you interested in fostering?
Personal References
Please list people familiar to both you and your pets.
Reference
Please include their name, address, phone number and email address.
Reference
Please include their name, address, phone number and email address.
By submitting this form, I certify that this information is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed veterinarian. I understand that false information may result in nullifying this adoption. This questionnaire remains the property of the Pet OverPopulation Prevention.

Adoption - Canine

Family & Housing

Other Pets

Veterinarian

The Dog You Wish to Adopt

Personal References