A&F ETS Survey

Microchip Number: Required only for BPF’s Microchips

Is this a foster-to-adopt that was placed during Empty the Shelters?*

YesNo

Name of shelter where you adopted?

Your Name*

Pet’s Name*

Email address

Confirmation Emailexample@example.com

Type of pet you adopted today*

DogCatOther

Is your pet microchipped?*

YesNo

If yes, has the microchip been registered with your contact info in case your pet gets lost?

YesNo

Have you owned a pet before?*

YesNo

If yes, have you adopted from a shelter or rescue before today?

YesNo

Dogs: How many dogs do you currently have at home? *

Cats: How many cats do you currently have at home? *

Other Pets: How many other pets do you currently have at home? *

Your age:

18-2930-3940-4950+

Did you know that when you buy a BISSELL product, you are helping support BISSELL Pet Foundation's great work? Every purchase saves pets!*

YesNo

Did you have a good experience?*

YesNo

If no, please explain:

How did you hear about the event?

Share photos & updates using #EmptyTheShelters, #BISSELLHappyTails, and follow us on social: Cathy Bissell & BISSELL Pet Foundation (Facebook), @cathy_bissell & @bissellpets (Instagram)

By signing below, I hereby confirm that I am the adopter of the above-mentioned pet and certify that the information completed is true and correct to the best of my knowledge. I acknowledge responsibility for the emotional and medical wellbeing of the pet from this date forward. If I am no longer able to care for the pet, I will notify the shelter/rescue listed above. I understand that BISSELL Pet Foundation reserves the right to follow up on the pet I adopted today. I understand that BISSELL Pet Foundation reserves the right to pursue prosecution if the pet has been rehomed without permission from the shelter/rescue, or if there are concerns about the pet’s wellbeing.

Signature*

Clear

Date*

Date

THANK YOU FOR CHOOSING ADOPTION!

WE WOULD LOVE TO HEAR YOUR STORY!