Adoption Questionnaire for Rainbow Bridge Can Wait

Adoption Questionnaire for Rainbow Bridge Can Wait

**we reserve the right to not disclose the reasons why applicant may be denied or not chosen**
Who are you interested in adopting?
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Housing : Do you ...
Type of home
Renter Info:
Does your landlord allow pets?
Is there a pet deposit required?
How much is it?
Is there a breed restriction or weight restriction in your lease?
If yes, what are the restrictions?
Name, address and phone number of landlord
Do you give us permission to contact your landlord and verify the pet policies?
How long have you been at your current residence?
Do you plan to move in the next 12 months? If yes, please explain.
Do you have an enclosed, fenced in yard attached to your home?
yes or no
Type of fence
Height of fence
What size is your fenced in yard?
Occupation
Employer :
Employers Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How often do you travel for work or pleasure?
Are you a student?
yes or no
How long are you typically away from home?

Other
Number of Adults in the household
Number of children in household and age of children
Do all adults in the household consent to the adoption of this companion?
yes or no
Does anyone in the household have any known allergies to cats, dogs or other animals? If yes, please state to what.
This pet will be kept:
Where will this companion stay daily when no one is home? ( Please be specific)
Where will this companion stay when you travel?
Have you taken into consideration how much it costs to support this new companion per year including but not limited to : food, routine annual vet care, heartworm/flea prevention, pet insurance, travel care, and emergency/illness vet care?
Please select yes or no to previous question
Where will this pet sleep at night? (please be specific)
Are you willing to purchase a crate if needed?
Do you have a pet door/doggy door/cat door?
Are you planning to enroll your companion in professional training program?
Are you willing to take this companion to obedience class and/or commit to professional training if NECESSARY for your new companion?
Do you plan to walk your dog OFF leash in unfenced areas? If yes, when/where?
Do you plan to visit off leash dog parks with your companion?
What made you want to adopt this companion?
Have you ever adopted an animal before?
If yes, from who?
Have you ever given up an animal for any reason? If yes, please explain.
Have you ever euthanized an animal for any reason other then a terminal illness? If yes, please explain.
Are you getting this companion for :

Other
What reason would you give up a companion? Select as many as apply:

Other
Use this space to explain any reasons you would rehome if needed.
Please tell us what behaviors you are unwilling or unable to work through with your new companion (after initial adjustment and training period are attempted)? select all that apply

Other
Use this space to elaborate on what behaviors you are unwilling to work through if needed.
Are you willing to call us for advice and work with a trainer on any of these issues if a problem persists?
Who will be the primary caregiver?
What type of food do you feed? Please be specific.
Do you want your pet spayed or neutered?
Do you plan to chain your pet in the yard?
Can you keep your new companion away from your other pets in the house for at least 2 weeks when you are unable to monitor their interaction?
Total number of pets currently owned:
Dogs
Cats
Other
Are all companions in the household current on shots?
If no, please explain
Are your companions on a heartworm preventative?
If yes, what brand?
Given on what day?
Please explain what you believe causes heartworms?
Please explain what you believe the cost and risks of treating active heartworm disease
What do you use for flea prevention?
Do you know the risk of an expired rabies for you or your companion? Please explain
Name and phone number of veterinarian who have seen your current/past companions in the last 5 years.
Please give us two personal references ( name and phone number)
Do you give us permission to contact your vet and personal references, and if needed to do a home check?
Please list all companions currently owned and/or owned in the past 12 years. Include all pets currently living at the property.
Cat, dog, other?
Name, breed, sex, and age
How long have you had this companion?
Is this companion spayed or neutered?
If a cat, were they declawed?
Do you still have this companion? If not, why?
Was this companion kept :
PLEASE DO NOT HIT SUBMIT IF YOU NEED TO ADD MORE COMPANIONS TO THE LIST. CLICK ADD MORE COMPANIONS THEN COME BACK TO SUBMIT.
- Cat, dog, other?
- Name, breed, sex, and age
- How long have you had this companion?
- Is this companion spayed or neutered?
- If a cat, were they declawed?
- Do you still have this companion? If not, why?
- Was this companion kept :
- Cat, dog, other?
- Name, breed, sex, and age
- How long have you had this companion?
- Is this companion spayed or neutered?
- If a cat, were they declawed?
- Do you still have this companion? If not, why?
- Was this companion kept :
- Cat, dog, other?
- Name, breed, sex, and age
- How long have you had this companion?
- Is this companion spayed or neutered?
- If a cat, were they declawed?
- Do you still have this companion? If not, why?
- Was this companion kept :
- Cat, dog, other?
- Name, breed, sex, and age
- How long have you had this companion?
- Is this companion spayed or neutered?
- If a cat, were they declawed?
- Do you still have this companion? If not, why?
- Was this companion kept :
- Cat, dog, other?
- Name, breed, sex, and age
- How long have you had this companion?
- Is this companion spayed or neutered?
- If a cat, were they declawed?
- Do you still have this companion? If not, why?
- Was this companion kept :
- Cat, dog, other?
- Name, breed, sex, and age
- How long have you had this companion?
- Is this companion spayed or neutered?
- If a cat, were they declawed?
- Do you still have this companion? If not, why?
- Was this companion kept :
- Cat, dog, other?
- Name, breed, sex, and age
- How long have you had this companion?
- Is this companion spayed or neutered?
- If a cat, were they declawed?
- Do you still have this companion? If not, why?
- Was this companion kept :
- Should be Empty: