new-application

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?