A New Beginning Animal Rescue (ANBAR) Pre-Adoption Questionnaire

A New Beginning Animal Rescue (ANBAR) Pre-Adoption Questionnaire
Name*
Pet to be adopted*
Email Address*
example@example.com
Address

Address

Street Address Line 2

CityState / Province

Zip
Phone: (Home)
(Work)
(Alt)
Are you at least 18 years old?*

YesNo
ID or Drivers Lic.
Do you:*

OwnRentLive with parentsOther
If, Other:
If you rent, landlord's name & phone #:
If you rent, are pets allowed?

YesNo
Is a pet deposit required?

YesNo
If a pet deposit is required, how much?
3. List all other members of your household and their ages:
Name/Relationship
Age
Name/Relationship
Age
Name/Relationship
Age
Name/Relationship
Age
Name/Relationship
Age
This pet is for:*

MeFamilyMy ChildrenParentsFriendOther
If Other:
5. Why do you want to adopt a pet? Check All That Apply:*

House petCompanion for meCompanion for childrenGuard DogBarn cat/mouserOther
Other
6. How do you plan to keep your new pet confined to your property? Check All That Apply*

In the houseKennel/CrateFenced yardTie-out chainGaragePatio AreaOutside dog runBasementOther
Explain
7. Where will your new pet be kept during the day?*
Night?*
Who will be responsible for the daily care of this pet?*
9. What pets do you currently have?*

NoneDogsCatsOther
Dogs #
Cats #
Other
10. Please list prior pets (from last 10 years) and why they are no longer with you:
Pet / Type
Reason
Pet / Type
Reason
Pet / Type
Reason
Pet / Type
Reason
11. Are your current pets spayed / neutered?

YesNo
Why not ?
Do you plan on having your new pet to be declawed?*

YesNo
Do you plan on having your new pet to be tail docked?*

YesNo
Do you plan on having your new pet to be ears cropped?*

YesNo
13. Who is your current veterinarian?
14. Are you financially able and willing to provide regular veterinarian check-ups and medical care new pet becomes sick or injured?*

YesNo
If no, why not?
15. If you have small children:
- (a) Do you understand that kittens/cats sometimes scratch and that the interaction between children and Pets must be supervised by a responsible adult at all times?
I understand (initial)*
15. If you have small children:
- (b) Do you understand that you must teach your children to respect all pets (i.e., leave it alone when I understand (initial) It starts to fuss) to prevent an accidental bite/scratch?
I understand (initial)*
16. Which of the following behavioral issues do you feel you'd be able/willing to deal with ?*

chewingfence jumpingbarking/whiningaggression towards other animalsfear/shynessdiggingseparation anxietynoise phobiascratching carpet/furniture/peoplenipping/biting
17. What training method(s) do you plan to use?*
18. Is there a history of allergies in your family?*

YesNo
If an allergy is discovered and you find you must relinquish the pet, are you prepared to keep the pet Until ANBAR can find a new home for it or pay to have it kenneled which may take up to a month*

YesNo
19. Are you in the military?*

YesNo
Is it possible you will be transferred?

YesNo
Have you relocated in the past with pets?

YesNo
What would you do with your pet(s) if you do get transferred in the future?
20. How do you plan to transport your pet?
I realize that adopting a companion animal can easily be a 15-20 year commitment and have given considerable thought to this adoption. I do understand that it may take a while for my new pet to adjust to its new environment. I will sincerely try to give this pet enough time to make the adjustment. In the event that I choose to return this pet to A New Beginning, depending on the circumstances, I may have to relinquish all adoption fees.

If I am unable to keep this animal for ANY reason, I agree to contact A New Beginning and arrange to return it, understanding that A New Beginning reserves the right to prosecute in the event this animal is ever abandoned or taken to a shelter.

I agree to provide my new address/phone number whenever I move so that if this pet is ever lost, I can be contacted and reunited with this pet. I also agree to contact A New Beginning in the event my pet is ever lost or missing.

I understand that this is an adoption and not a sale and that A New Beginning reserves the right to postpone, refuse, or decline any adoption for any reason we deem appropriate. I certify that the above information is true and I understand that any false information can result in the cancellation of this adoption and a forfeiture of any fees paid to A New Beginning.
Adopter Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: