PLEASE CUT AND PASTE THIS FORM INTO AN EMAIL MESSAGE OR PRINT IT, FILL IT OUT, AND FAX IT IN TO US AT 920-294-0834.
Adoption Questionnaire
Pet interested in:
Adopter:
First Name________________________________MI_____Last Name_______________________________
Date of Birth__________________
Spouse/Other Adult in Household:
First Name________________________________MI_____Last Name_______________________________
Date of Birth__________________
Address (No P.O. Box)________________________________________________________________
City____________________County________________________State______Zip_________________
Home Phone_____________________________Alternate Phone_______________________________
Email_______________________________________________________________________________
How many adults in your home?________How many children in your home?_______Ages?__________
Do you own your home? [ ] Yes [ ] No Please provide landlord first and last name, and phone number.
Landlord_________________________________________Phone_________________________
Please note that we do confirm home ownership or obtain landlord approval for ALL potential adopters.
Have you ever adopted from a shelter or humane society?_____Where?_____________________
Have you ever been refused adoption from a shelter or humane society?_____Why?___________
Have you ever taken an animal to a shelter or humane society?_____Why?__________________
Please list any pets you’ve owned in the last five years.
Name Breed Indoor/Outdoor Age Sex Altered Still Own? Why not?
Veterinarian_____________________________________________Phone____________________________
Have you ever been convicted of a crime (other than traffic violations or civil judgments)?_____
Please describe__________________________________________________________________
By signing this agreement, I certify that the information I have given is true,
and I recognize that any misrepresentation of the facts may result in my losing the privilege of adopting a pet.
I understand that Green Lake Area Animal Shelter, Ltd. has the right to deny my request to adopt an animal.
I understand that this information could be made available to other shelters.
This form will become the property of Green Lake Area Animal Shelter, Ltd.
Signature of Applicant______________________________________Date_________________Time________________
Dog Adoption Questionnaire
Who will be the primary caregiver for this dog, responsible for feeding, grooming, exercising, training, and clean up?
______________________________________________
How much time are you prepared to allow your new pet to adjust to its new home?
_________________________________________________________________________
How many hours per day will this dog spend alone? _______________________________
How many hours per day will this dog spend outside? ______________________________
Where will the dog be kept when you’re not home and/or at night?
_________________________________________________________________________
_________________________________________________________________________
Please describe your available yard space.
__________________________________________________________________________
Are you familiar with the needs and characteristics of the breed you’ve chosen, please describe?
__________________________________________________________________________
What type of food and feeding schedule do you plan to use?
__________________________________________________________________________
What is the worst behavior problem a dog could have,
and how will you address training or behavior problems? Who will you call for assistance?
Do you want this dog to Hunt Herd Companion Guard Obedience Competition?
How much do you think you’ll spend per year on the care of this pet, including food, routine or emergency medical care, toys, etc.?
__________________________________________________________________________
If you have other pets, how will you handle introductions or fights between them?
If you move or become unable to care for your new dog,
are you willing to return him/her to the Green Lake Area Animal Shelter?
________________________________________________________________
____________________________________________________________________________________
Cat Adoption Questionnaire
Who will be the primary caregiver for this cat, responsible for feeding, grooming, exercising, training, and clean up?
_____________________________________________________________________________
How much time are you prepared to allow your new pet to adjust to its new home?
_____________________________________________________________________________________
Please describe your litterbox set-up and placement
Are you aware that you should have the same number of litterboxes as cats,
plus one, and that they should all be in separate locations?
_______________________________________________________________
If you have cats now, do they all use the litterbox consistently without accidents?
_____________________________________________________________________________
Will you let your cat outdoors? ____________________________________________________________
What characteristic is it most important for this cat to have?
______________________________________________________________________________________
Examples: Playful Friendly Calm Quiet Clean Independent
What type of food and feeding schedule do you plan to use?
______________________________________________________________________________________
Do you plan to declaw your cat? __________________
Are you aware of the possible effects? _____________________
If you are, what is your reason for proceeding with the declaw?
_______________________________________________________________________________
Are you interested in training your cat to use a scratching post?
_____________________________________________________________________________________
What is the worst behavior problem a cat could have, and how will you address training or behavior problems?
Who will you call for assistance?
How much do you think you’ll spend per year on the care of this pet, including food, routine or emergency medical care, toys, etc.?
__________________________________________________________________
If you have other pets, how will you handle introductions or fights between them?
If you move or become unable to care for your new cat,
are you willing to return him/her to the Green Lake Area Animal Shelter?
____________________________________________________________________________________
