Dog Questionnaire Application

Adoption Fees

Puppy (under 1 year) $ 300

Adult dog $ 200

Senior dog (OVER 8 years) $ 100

To Adopt a dog you must

- Be at least 18 years old

- Understand that Suruluna Animal Rescue reserves the right to deny the adoption of any pet for any reason.

Dog(s) you are interested in

Adopter's Name

First & Last Name

Co-Adopter's Name

First & Last Name

Address

Street Address

Street Address Line 2

CityState

Zip Code

Adopter's E-mail

Co-Adopter's E-mail

Phone Number - Home

Area CodePhone Number

Phone Number - Cell

Area CodePhone Number

Names and ages of all permanent residents of your home (adults/children)

Name and phone number of your employer

Vet reference (please call your vet and give permission to release information to us)

Vet name, address & phone number

Are you planning to move in the near future?

Are you willing to have Suruluna come for a home visit?

Will this be your first dog as an adult?

Current pets in your home: Name, Species, Ages, Sex, Spayed/Neutered

Please list the kinds of pets that you had in the past. If you no longer have them, please list why.

Have you ever surrendered or re-homed your dog?

If yes, please give details

I/We live in a

Do you rent or own this property?

If you rent please provide the info (name and contact number, email) of your landlord/management - If you have a Condo/Townhouse please provide contact information for any management or Home Owner Association

If you rent, we must have the authorization from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any specific limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.

Are you familiar with any regulations and restrictions regarding dogs in your home?

If you are not sure about the regulations Suruluna might ask for a copy of your lease and/or a written authorization from your landlord/management.

Do you have a yard?

Do you work outside the home?

How many hours per day will this dog be alone?

Have you discussed this adoption with all members of your household?

We require that all household residents are aware of this application process and that they come to meet the dog prior to any final decision.

If you are approved to adopt and you already have another dog(s) you will also be required to bring the dog for an introduction.

Are you aware of the costs of caring for a dog for his life time? (Vet care, food, toys, possible training, pet boarding/sitting etc.)

What activity level do you prefer?

Other

Please check all that apply. My adopted dog will...

Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?

What would you do if your dog was diagnosed with an expensive health condition?

Two Personal references (no family members)

Please note that you will be adopting from a Rescue/Sanctuary and you will be required to sign an agreement that you will not euthanize the dog without consulting with Suruluna.

Please check this box, sign, and click Submit to confirm that you have read the above.

Applicant's Signature

Co-Applicant's Signature

Signature date

After you submit this form we will review your application and get in touch to set up a visit to meet the dog(s) of your choice.

Questionnaire - Application for Suruluna