Name: Phone:
Name: Phone:
Name: Phone:
Veterinarian where your pets records are: Veterinarian phone number and address:
Can you afford regular veterinary care for the new pet?
Yes No
Do you agree to have annual checkups and all vaccinations administered by a
licensed veterinarian?
Yes No
How many children are in your household and what are all of the ages?
If you don't currently have children, are you planning on having children in the future? Yes No Maybe
If you did have children at a later date, would this make you want to give up your pet?
If you have young children, they need to be educated on how to interact with the dog in order to prevent dog bites, are you able/willing to do that?
No Yes
How many adults are in your household?
--no selection--
1
2
3
4
5
6 or more
Who will be the one looking after your new pet?
Are other members of your household in agreement with the adoption? Yes No Not sure Haven't
discussed it
Where will the dog be left when alone?
How many hours will your dog be left alone a day?
--no selection--
1 hours
2 hours
3 hours
4 hours
5 hours
6 hours
7 hours
8 hours
9 hours
10 hours
11 hours
12 hours
13 hours
14 hours
15 hours
16 or more hours
Do you plan on doing obedience training with your new animal?
Yes No
Maybe
What are your feelings about crating the animal?
Do you have a fence?
Yes
no
Will be putting one in soon
what kind do you have
none
chain
wooden
undergroud shock
wooden and chain
other
How high is the fence?
If you do not have a fence how will the dog safely be let out to relieve itself?
What form of discipline will you use? What have you used in the past with other pets?
Do you or have you ever bred animals?
Yes
No
Thought about it
If you do currently breed animals or have bred in the past,please explain:
What would make you want to give up on a dog? please select the best answer
Nothing
agression to me
agression to kids or other people
chewing
urinating in places he is not supposed to
barking
digging
jumping the fence
too hyper
chases my cats
does not get along with my other animals
steals food from the counter tops
chews up furniture
chews on anything he can find
too layed back of a dog
I'm having a baby
I'm moving and don't want to take the dog
eats his feces
jumping on myself or other people
digging up my flower garden
I'm going on vacation
one or more of the above options
If you selected more then one answer from the above question please explain
Do you realize that you will probably have to housetrain your new puppy/dog?
No Yes
What will you do if your dog shows destructive behavior? (Digging, chewing, jumping, tearing up plants/furniture or running off)
--no selection--
Hit the dog
take the dog to training
train the dog yourself
nothing let him continue
scream at the dog
give the dog away
chain him outdoors
put him in a crate and keep him there
How long will you give this dog to adjust to its new home
--no selection--
1-2 days
1 week
2 weeks
3 weeks
4 weeks
5 weeks
6 or more weeks
as long as needed
If your dog ran away what would you do?
Have any of your animals ever accidently been loose before? How did it happen?
If you have an animal in your residence now, have you ever introduced it to a new animal? Yes No Don't have other animals
If "Yes," how did your pet react?
Favorably Difficult Adjustment Indifferent
If you move in the future, what will you do with the animal?
Why are you looking for a pet? How long have you been searching?
Are you looking for a pet for yourself or someone else? If someone else, please explain who.
Do you realize that dogs often live longer than 10 years and are you willing to assume responsibility for that long?
No Yes
Are you familiar with heartworm disease?
No Yes
Will you maintain your dog on heartworm preventative?
No Yes
Do you rent or own your current residence?
Rent Own What type? House Mobile
Home Apartment Condominium If RENTING: Landlord's Name: Phone: Will the landlord allow pets? Yes No If YES, are there any restrictions?
Pet Deposit (in U.S. dollars): $
Comments/Suggestions/Concerns
Where did you hear about A Few Steps From Home??
--no selection--
www.fewstepsfromhome.homestead.com
friend
petfinder.com search
internet search
relative
Petsmart in Saginaw
pets 911
1-800-save-a-pet
Flyers
Veterinarian Clinics
other
All of the information that I have provided in this application is true and accurate to the best of my knowledge.
Applicant's Initials: