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Dog Adoption Questionnaire

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This form has been modified since it was saved. Please review all fields before submitting.

Steps

1. Personal Information This section is complete This section is incomplete
2. Household Information This section is complete This section is incomplete
3. Adoption Preferences This section is complete This section is incomplete
4. Dog Care This section is complete This section is incomplete

Personal Information

Please list the name(s) of the dog(s) you're interested in:*
Please be aware we are unable to respond unless a specific animal is referenced by name or ID#.
How did you hear about us?*
When will you be ready to bring your new pet home?*
Please explain when you would be able to take your new pet home:
Are you 18 years of ago or older?*
This form must be completed by a legal adult.
1. Yes
First Name*
Last Name*
Address*
Unit #
City*
State*
Zip*
Mailing Address (if different than above) Including City and Zip
Primary Phone Number*
Phone Type*
Secondary Phone Number*
Phone Type*
Date of Birth:
Date of Birth:
Email*
We will use this email address to communicate with you.
Emergency Contact Name/Phone Number (for microchip):*
Continue

Household Information

Do you live in a:*
1. House
2. Apartment
3. Condo
4. Duplex
5. Parents' Home
6. Other
Please explain:*
Do you:*
1. Rent
2. Own
3. Other
Please explain:*
What is your landlord's pet policy?*
Please list all household members, including their name, relationship to you, and age if under 18:*
Is anyone in your household allergic to dogs?*
Are there children who frequently visit the home? If yes, what are their ages?*
Who will be the person primarily responsible for this pet's care?*
Do you anticipate any major changes to your lifestyle in the next six months? Please explain:*
For example, new baby, moving, new career, roommate or spouse.
How long on a typical day will this pet be left alone without people?*
My household's activity level is:*
Do you have a fenced yard?*
Do you have chickens or livestock on your property?*
Are there other pets in the household?*
1. Yes
2. No
Breed/Type:*
Age:*
Sex:*
Spayed/Neutered?:*
Prior pets:*
Please tell us about any prior pets you've owned in the past 10 years, including how long you owned them and what happened to them:
Continue |Go Back

Adoption Preferences

Primary reason(s) for adopting*
Check all that apply:
1. Companion for self
2. Companion for children
3. Companion for other pet(s)
4. Watch dog
5. Hunting/herding
6. Service dog/Emotional support dog
7. Other:
Please explain:*
It's important the dog gets along with:*
Check all that apply
1. Children 8+ years
2. Children 4 - 7 years
3. Toddlers - 3 years
4. Other dogs
5. Cats
6. Small animals/birds
7. Horses/livestock
8. Other:
Please explain:*
Which of the following are desirable to you?*
Check all that apply:
1. A canine athlete - a dog with lots of energy who needs daily runs or vigorous exercise
2. A walking companion for long daily walks
3. A dog I can take to the dog park
4. A dog I can take hiking and camping
5. A dog who needs short walks only
6. A couch potato - a dog I can hang out with who doesn't need much exercise
7. A dog who can successfully live in an apartment
8. A dog to do specific activities with:
Please list specific activities:*
What is your preference on training?*
Please explain:*
What are your grooming preferences?*
Check all that apply:
1. I don't mind a dog that needs regular professional grooming
2. I don't mind brushing my dog daily
3. I prefer a dog that only needs weekly brushing or less
Do you have any other requirements for a new dog/puppy?
Continue |Go Back

Dog Care

Where do you plan to keep this dog during the day when you're home?*
Please explain:*
When you are away from home, where will the dog stay?*
Please explain:*
Where do you plan to have the dog sleep at night?*
When left alone do you plan on crating the dog?*
1. Yes
2. No
3. Sometimes/Only if needed
4. I'm not familiar with crate training
What problems do you feel unprepared for?*
Check all that apply:
1. Biting/Aggression
2. Housesoiling
3. Excessive barking/vocalization
4. Not good with other animals
5. Not good with children
6. Excessive grooming needs
7. Excessive activity level
8. Chewing/destructiveness
9. Confinement issues/running away
10. Medical issues
11. Other:
Please explain:*
Will you be able to take your new dog to your vet for a wellness exam within the next 30 days?*
How much do you expect to spend yearly on the care of this pet (for food, toys, veterinary care, etc.)? *
Are you willing/able to pay for emergency veterinary care, which could be $300-$1500 or more?*
What might cause you to return or rehome the dog?*
Is there anything else you'd like to discuss about adopting or you would like us to know?
Adoption commitment:*
Adopting a dog is a serious responsibility. The dog you adopt will likely be part of your family for the next 10 - 20 years and will make considerable demands on your time and resources. You will need to spend time training, socializing, brushing, feeding, scooping waste, exercising and playing with your dog on a daily basis. Dogs and puppies that have not been trained require even more time and socialization. All dogs require regular medical care, and some need special food, medication, or professional grooming. Vet bills, pet sitting, and vacation boarding fees may add considerable and sometimes unexpected expense to your family's budget. Are you prepared to accept the personal and financial responsibility of owning a dog, and do you accept that the Everett Animal Shelter makes no guarantees as to the health or temperament of any animal?
1. Yes
2. No
Thank you for completing this questionnaire! Please be aware that it may take up to a week for our staff to contact you, and we are unable to contact individuals if the requested animal is no longer available. We appreciate your patience!

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