Lilly

Contact Information

Full Name

Email

Phone number

Birthday

Address

City

State

Zip code

Employer

Adoption Questionnaire

What dog(s) are you applying to adopt?

Dog Name

Which of the following best describes your reason for wanting to adopt this dog?

Companion
Search and rescue
Guard dog
Agility
Hunting
Jogging
Obedience training
Walking buddy
Couch warmer

Under what circumstances would you NOT keep this dog?

What temperament and activity level are you looking for in a dog?

High energy
Outdoorsy dog
Lap dog
Mellow
Affectionate
Quiet
Guard dog

When it comes to relating to dogs, I tend to be more:

Strict, demanding (dog must learn and follow all commands)
Moderate (encouraging of good behavior)
Lenient (wishy, washy; easily coerced by the dog)

The noise/activity level of my home is usually:

High
Medium
Low

I would enjoy grooming my dog:

Rarely
Occasionally
Daily
Weekly
Monthly

I would prefer a dog that:

Would enjoy walking with me on a leash
Will exercise themselves in our yard
Would enjoy going to the dog park
Would run, jog or hike with me
Requires only enough exercise to do their business

My ideal dog would:

Bad dog habits that I cannot tolerate are:

Living Arrangements

Home type

How long have you lived at your current residence?

If renting, please provide the following:

Landlord Name

Phone number

Do you have a fenced in yard?

Yes No

Type of Fence

Are there any slats/openings that could allow a small dog to get in/out?

Yes No

How many adults live in your home?

How many children live in your home?

Ages

Does anyone in your household have allergies?

Yes No

Who will primarily be responsible for the care of this dog?

Animal Care

Veterinarian Name

Phone

How many hours per day will the dog(s) be left alone?

Weekdays

Weekends

When left alone, dog(s) will be:

Explain

Where will the dog be kept at night?

Pet History

Please list all of the pets you have had in the last 7 years including current pets and those you no longer own:

Species/Breed

Age

Sex

Adoption date

I understand and agree that Rescue PAC makes no expressed or implied warranty, representation or promise to the age, health, breed, habits, disposition or safety of the animal. I hereby accept the animal as is, assume all risks and responsibilities associated with the ownership of the animal, including bites, and I hereby fully and completely release, indemnify, and hold harmless Rescue PAC, its directors, officers, volunteers, servants, and employees from any claim, cause of action or liability of any sort or nature, whether known or unknown, directly or indirectly arising out of or in connection with the adoption, care or ownership, maintenance, temperament or condition of the animal.

I agree in the case I cannot keep the animal, he/she will be returned to Rescue PAC, and all monies, deposited with Rescue PAC will be considered a donation to the rescue and are non-refundable.

I acknowledge falsification of the above can result in my being denied adoption of an animal or if animal has been adopted to me, the return of that animal to Rescue PAC.

I certify that the above information is true and correct to the best of my knowledge.

Lilly

Apply to adopt!

Contact Information

Adoption Questionnaire

Living Arrangements

Animal Care

Pet History