First Name: *
Last Name *
Address:
City: *
Province *
Postal Code:
Phone: *
Work:
email: *
Name of dog or dogs interested in: *
Are you choosing this dog for yourself: Yes No
Is he/she going to be: Inside Outside Both
Who lives in the household:
Do you have any children under 19 years of age? Yes No
If so what are there ages?
Have you owned pets before? Yes No
If yes, what kinds? Dog Cat Bird Other
If you owned other animals in the past please explain what happened to them:
Do you have any pets at the moment? Yes No
Describe:
Dog; is it neutered/spayed? Yes No
Have your pets been vaccinated within the past year? Yes No
If yes list year and month: ...
If you owned pets in the past were they: Neutered/Spayed Vaccinated every year Vaccinated every 2 years
Why do you want a dog? To teach kids responsibility For breeding Guarding For company Hunting Other
How much time will you and your family have to spend with your dog each day? 15 - 30 min 30 min - 1 hour 1 hour or more
How much grooming do you expect to do? None Little Moderate Allot
Do you or anyone in your family have allergies to dogs? Yes No
Who will be responsible for the care of your dog? Child Adult
How active would you like your dog to be? Quiet Lively Very Lively
How long will your dog be left alone each day? Never 0 - 3 hours 3 - 6 hours 6 + hours
What size yard do you have? No Yard Condo or Townhouse Medium City Lot Large Acreage
Is your yard completely fenced? Yes No
How high?
Where would you keep your dog when you are not at home or at night? Outside
If outside will he/she be tied up? Yes No
Basement Shop Balcony In house Barn Garage In a run In a cage Other
If in the house where?
If you are adopting a dog will he/she be spending time in a crate each day? Yes No
If yes, explain why and how much time.
Will you be taking this dog through professional obedience training? Yes No
How often will you walk your dog and for how long?
How much money would you expect and are prepared to spend in a year on your dog? $100 - $300 $300 - $500 $500 - $1000
How often are you prepared to visit a veterinarian? (non-emergency) Once a month Once a year As required Never
What will you do with your dog when you go on holidays? Dog sitter Boarding kennel Leave with a friend
What will you do with this dog if you need to move? Take him/her with you Give to a friend Find a new home Give to the SPCA
Are you 19 years or older? Yes No
Do you? Rent Own home Live with parents
If you rent are you allowed to own a dog? Yes No
Please list your landlords name and phone number
Have you ever surrendered a pet to a humane society, SPCA or pound? Yes No
Do you agree to a Home Inspection prior to adoption? Yes No
Why do you think you will be a good home for this dog?
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