Freetown Adoption Inquiry Form

1

This questionnaire is designed to help determine if a specific dog is the right one for you and your household. All inquiring parties are required to complete this form prior to scheduling a meet and greet. We want to make the best use of our volunteers' limited time as well as yours.

2

Name of the dog you are interested in:* This field is required.

3

Are you aware that there will be an adoption fee associated with the dog you are applying to adopt? Are you prepared to make the adoption fee payment, in full, prior to finalizing the adoption?* This field is required.

Yes

No

4

Applicant's full name:* This field is required.

5

Your age:* This field is required.

6

Co-Applicant's full name (if living in same household as Applicant):* This field is required.

If there is only one applicant please type N/A

7

Your age:* This field is required.

8

Street Address:* This field is required.

9

City, State, Zip* This field is required.

10

Applicant's Phone:* This field is required.

Area Code

Phone Number

11

Co-Applicant's Phone:

Area Code

Phone Number

12

Applicant's E-mail:* This field is required.

13

Co-Applicants E-mail:

14

Applicant's Employer:* This field is required.

15

Co-Applicant's Employer:

16

1) Character reference and phone number:* This field is required.

17

2) Character reference and phone number:* This field is required.

18

Are all members of your household in agreement with this adoption?* This field is required.

Yes

No

Don't Know

Gift/Surprise

19

Who will be the pet's primary caregiver?* This field is required.

21

Do you own or rent?* This field is required.

Own

Rent

22

If rent, provide name and phone number of landlord:* This field is required.

23

Does your landlord allow dogs? Prior to completion of adoption a written consent form will be required from your landlord.* This field is required.

Yes

No

N/A

24

Are there any restrictions from your landlord or subdivision?* This field is required.

Number of pets

Size or weight restrictions

Breed restrictions

None

25

Do you have a fully fenced yard?* This field is required.

Yes

No

26

Height and type of fence* This field is required.

28

How many adults are in your household?* This field is required.

29

How many children are in your household?* This field is required.

30

If there are children in the home, what are their ages?

31

Have your children been around animals before?* This field is required.

Yes

No

N/A

32

Does anyone in your home have allergies to dogs or have asthma?* This field is required.

Yes

No

33

List any pets you own or have owned in the past five years, and their ages* This field is required.

34

Were these pets spayed/neutered? If not, why?* This field is required.

35

Where are these animals now?* This field is required.

36

Have you ever given up a pet?* This field is required.

Yes

No

37

If yes, what were the circumstances?* This field is required.

38

Please provide the name and phone number of your current and/or previous veterinarian or clinic:* This field is required.

39

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, outgoing, couch potato)* This field is required.

40

Are you aware of crate training?* This field is required.

Yes

No

41

Have you ever house-broken a dog or puppy before?* This field is required.

Yes

No

42

If the dog has an "accident" in your home, what type of correction do you plan to use?* This field is required.

43

How many hours each day will your new pet be home alone?* This field is required.

44

Where will your new pet sleep at night?* This field is required.

45

How will you supervise the dog's outdoor activity?* This field is required.

46

Where will your new dog stay when nobody is home?* This field is required.

47

What length of time will you allow your new pet to adjust to their new home? (Adjustment can include: slow to bond to new family members, anxious behavior, regression in training)* This field is required.

48

Are you willing to work through your new pet's issues, if any?* This field is required.

Yes

No

49

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?* This field is required.

Yes

No

50

Do you understand that a dog can be an 18 year commitment, and can cost $1000s per year to care for?* This field is required.Examples include monthly preventative medications, quality dog food, grooming on a recommended schedule for the breed(s), natural chews, enrichment toys/puzzles, training treats, professional training consultations

Yes

No

51

Do you plan to take an obedience class with your dog?* This field is required.

Yes

No

Not sure

52

If yes, where?Feel free to step away from the application and research options in your area before answering

53

What circumstances would lead you to give up your new dog?* This field is required.We all assume it won’t happen to us but it’s important to consider the possibilities seriously.

54

If under any circumstances you were unable to keep your dog, Freetown requires that you agree that the dog will be returned directly to the rescue and will not be rehomed to another party, unless prior written consent is received from Freetown. Do you agree to these terms?* This field is required.

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