ANBAR Pre-Adopt Questionnaire

Name

Pet to be adopted

EMAIL Address

example@example.com

Address

Street Address Line 2

City

Zip

Phone: (Home)

(Work)

(Alt)

1. Are you at least 18 years old? YES NO ID or Drivers Lic.

NO

ID or Drivers Lic.

Own

Rent

Other

If you rent, landlord's name & phone #: If you rent, are pets allowed?YES

YES

NO

Is a pet deposit required?

NO

3. List all other members of your household and their ages: Name/Relationship Name/Relationship Name/Relationship Name/Relationship Name/Relationship

Age

Name/Relationship

Age

Name/Relationship

Age

Name/Relationship

Age

Me

FamilyOther

5. Why do you want to adopt a pet? Check All That Apply:

companion for children

barn cat/mouser

Other

6. How do you plan to keep your new pet confined to your property? Check All That Apply

In the house

Kennel/Crate

Outside dog run

Tie out chain

Tie-out chain

Garage

Patio Area

Basement

Explain

7. Where will your new pet be kept during the day?

night?

8. Who will be responsible for the daily care of this pet?

Who will be responsible for the daily care of this pet?

9.What pets do you currently have?

None

Dogs #

Cats #

Other

10. Please list prior pets (from last 10 years) and why they are no longer with you: Pet / TypeReason Pet / TypeReason Pet / TypeReason Pet / TypeReason

Pet / Type

Reason

Pet / Type

Reason

Pet / Type

Reason

Pet / Type

Reason

11. Are your current pets spayed / neutered?

YES

NO Why not ?

Why not ?

YES

12. Do you plan on having your new pet: declawed? tail docked? ears cropped?

YES

NO

YES

NO

13. Who is your current veterinarian?

YES

14. Are you financially able and willing to provide regular veterinarian check-ups and medical care if your NO Why not ? New pet becomes sick or injured?

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) (b) Do you understand that you must teach your children to respect all pets (i.e., leave it alone when 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 ?chewing

fence jumping

barking/whining

aggression towards other animals

separation anxiety

nipping/biting

noise phobia

scratching carpet/furniture/people

nipping/biting

digging

17. What training method(s) do you plan to use?

YES

18. Is there a history of allergies in your family? 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

YES

NO

19. Are you in the military? Have you relocated in the past with pets? What would you do with your pet(s) if you do get transferred in the future?

YES

NO

Is it possible you will be transferred?

NO

YES

NO

YES

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,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 it, understanding that abandoned or taken to a shelter.

reserves the right to prosecute in the event this animal is ever

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 in the event my pet is ever lost or missing.

I understand that this is an adoption and not a sale and that 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

Adopter Signature

Date