Animal Connections


Dog Pre-Adoption Questionnaire
Last First Middle Suffix (Sr., Jr., III, etc.)
   
Address: 
City, State:                      Zip Code (5 digits):
 
Home Phone: (Please include area code)    
 Work Phone: (Please include area code)  
 Cell Phone: (Please include area code)  
Email: Occupation:
   

Name or description of dog you are interested in (up to 250 characters):


This dog will primarily be:
Housedog
Outside Dog

Does anyone in your family have allergies? If so, explain (up to 250 characters):

Number of adults in the home
Do they all work outside the home?  Yes No
Who will be the dog's primary caretaker?
What is the longest period the dog will be left alone? days hours
Where will the dog be left?
Have you ever surrendered a pet or given a former pet to an animal shelter? Yes No

Please give names and ages of children in the home:

Do you own your current residence? Yes No
How long at this address? less than 1 year between 1-3 years 3 years or more
 
Do you rent your residence? Yes     No
Does your lease allow pets? Yes     No
If you rent your residence, please fill-in the following fields. If not, please check the omit box at the bottom of this paragraph:

This Field is Omitted
landlord's name:
phone number (please include area code):
 

Type of residence:
Do you have a fenced yard? Yes No
If not, how and where will the dog be exercised? (maximum of 500 characters):


Describe what animals are currently living in your household? Please include important information such as type of pet, sex, where it is kept and whether it is spayed/neutered (if applicable). 


Veterinarian's name:
Veterinarian's phone number:


Please tell us about your previous pets? This doesn't apply to me. continue to the next field.
Please include important information such as type of pet, sex, where it is kept and whether it is spayed/neutered (if applicable).

What happened to them? (max 1000 characters)


Please supply the name, address, and telephone numbers of two personal references (non-relatives):

Reference 1:
Name
Address
Telephone Number

Reference 2:

Name
Address
Telephone Number

  I certify that the information I have given above is true and correct, and I hereby authorize the above listed veterinarian(s) to supply information in regard to my pets to the Animal Connections. I also give my permission to the Animal Connections provider to contact the above listed landlord and references.
 

Note: Once you hit the submit button, you will return to the dogs page and your application will be processed right away. Please give at least 5-7 business days for your application to be processed. Animal Connections reserves the right to deny any application.

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