Adoption Questionnaire - Canine

Adoption - Canine

Please list the Name of the animal you are interested in adopting.*
Your Name*
First Last
Driver's License / ID#*
Date of Birth*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Work Phone
Cell Phone
Email*
Emergency Contact (Full Name)
First Last
Emergency Contact Phone
Household
What type of housing do you live in?*
Do you rent or own your home?*
If renting, do you have your landlord's permission to adopt a pet?*
Please list the names of all your household members. Include ages for those under 18 years.*
Who are you adopting this pet for?*
Who will be primarily responsible for the care and supervision of the animal?*
Will this dog be in the presence of children frequently?*
If yes, what ages are the children?
My adopted dog will primarily be an...*
How will you confine your adopted dog to your property when outdoors?*
When I'm not at home, my dog will spend his / her time...*
Long Term Care
What will happen to this dog if you move?*
Do you have a Veterinarian for your pet(s)?*
If yes, please list the name of the clinic
Approximate date of last vaccinations for your current pet(s)
How many pets are in your home?
Are all your pets spayed or neutered?
Please list the pets that you have had in the past five years (both current and those you no longer own)
Breed / Age / Gender / Spayed or Neutered / How long owned? / What happened to him or her?
By submitting this form, you certify that this information is true and understand that false information may result in nullifying this adoption. This questionnaire remains the property of the Pet OverPopulation Prevention.

Adoption - Canine

Household

Long Term Care