preliminary Adoption Questionnaire

Name *

First Name

Last Name

Phone * *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

House or apartment? *

House

Apartment

Do you have a pool? *

Yes

No

If yes, is it gated? *

Yes

No

Are you at least 21 years of age? *

Yes

No

Married or single? *

Married with children living in the home

Married with no children

Single

Are you employed? *

Yes

No

Have you ever relinquished a pet at a city shelter? *

Yes

No

Can you provide emergency Veterinary care for your pet should the need arise? *

Yes

No

Have you researched the breed you are inquiring about, or have you ever owned this breed before? *

Yes

No

Do you currently have any other pets in the home? *

If yes please list additional pets owned in box below.

Yes

No

Are your current pets spayed and/or neutered?

Yes

No

Are your current pets tolerant of other animals in the home? *

Please explain any concerns below.

Yes

No

Would you ever keep a pet outside in the yard to live? *

Yes

No