Adoption Questionnaire

Cookies Canine Animal Rescue Adoption Questionnaire

Date:*

MonthDayYear

Pet's Name*

Applicant's Name*

First NameLast Name

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Emergency Contact*

Phone Number*

Area CodePhone Number

Personal Reference (non-family member)*

Phone Number*

Area CodePhone Number

Your Veterinarian*

Phone Number*

Area CodePhone Number

Are you prepared to make a 12-16 year commitment to this pet?*

Are you prepared to care for this pet financially?*

Are you willing to provide the REQUIRED monthly heartworm medication?*

Are you adopting this pet for: pet companion, yourself, or child?*

List the name, breed and ages of any other pets in the home*

Do you agree to have your present pet meet the new pet to ensure they will be compatible?

Are your pets spayed or neutered?*

Are your pets current on all vaccinations?*

Name of previous dog(s)

Name of previous vet

Are you prepared to spend quality time with this dog daily?*

How many hours IN TOTAL will this pet be left alone daily?*

If hours are not consecutive, please explain.*

Where in the house will this pet stay when you are not at home?*

Where will this pet stay when you are out of town?*

Where will this pet sleep?*

Are you prepared to deal with behavioral problems?*

Are you prepared to deal with any housebreaking training?*

Do you or anyone in your family have allergies to pets?*

Do you own or rent your home?*

If you rent, has your landlord given permission to own a pet?

Do you have proper accomodations for this pet? Please describe:*

Landlord's Name

First NameLast Name

Landlord's Phone Number

Area CodePhone Number

If you move will you take your pet with you?*

How much time will this pet spend outside daily?*

Do you have a fully fenced in yard?*

If yes, please describe your fence:*

How would you deal with any destructive problems?*

Have you ever surrendered a pet?*

If you have surrendered a pet, please explain:*

Would you ever consider giving up your pet? If yes, please explain:*

If your pet develops serious or chronic medical problems what would you do?*

Do any children live in the household?*

Please list the ages of children*

How many adults live in the household?*

Please list names of adults and relationship to applicant*

What best describes the pet's primary caregiver:*

Official Daily Work Hours:*

Time you leave home for work:*

Time you get home from work:*

Signature*

MonthDayYear

Employer*

Employer's Phone Number*

Area CodePhone Number

Employer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry