BISSELL Pet Foundation's Empty the Shelters Adoption Survey
Your adoption has been sponsored by BISSELL Pet Foundation. Please complete the below survey in order to ensure the shelter you are adopting from receives the grant funding.
Name:
*
Pet's Name:
*
Email Address:
*
Name of shelter you adopted from today:
*
Type of pet you adopted today:
*
Dog
Cat
Other
Is your pet microchipped?
*
Yes
No
Has the microchip been registered to your contact information in case the pet gets lost?
*
Yes
No
Have you owned a pet before?
*
Yes
No
Have you adopted from a shelter or rescue before today?
*
Yes
No
How many dogs do you currently have at home?
*
0
1
2
3+
How many cats do you currently have at home?
*
0
1
2
3+
How many other pets do you currently have at home?
*
0
1
2
3+
What is your age?
30 or younger
31-50
51-70
70+
Did you know when you purchase BISSELL you are helping save pets? Every purchase saves pets!
*
Yes
No
Did you have a good experience during Empty the Shelters?
*
Yes
No- please explain
How did you hear about the event?
*
Word of Mouth (Friend or Family)
Social Media (Facebook, Instagram, Twitter, etc.)
Television
Internet (Non Social Media
Shelter
Radio
Print
Other
I confirm that I am the adopter of the above-mentioned pet.
*
Yes
The information in this form is true and correct.
*
Yes
I acknowledge responsibility for the emotional and medial well-being of this pet from this day forward.
*
Yes
I understand that BISSELL Pet Foundation reserves the right to follow up on the pet I adopted today.
*
Yes
If I am no longer able to care for this pet, I will notify the shelter/rescue listed on this form.
*
Yes
I understand that BISSELL Pet Foundation reserves the right to enforce the terms of this Agreement and may pursue prosecution if this pet is rehomed without permission from the shelter/rescue or if there are concerns about the wellbeing of the animal.
*
Yes
By printing my full name below I agree to the terms of this agreement:
*
Please enter today's date:
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: