Dog Adopter Survey

Dog Adopter Survey

Name (first and last) *

Street Address *

Apartment

City *

State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *

Primary Phone *

Secondary Phone *

Email *

Driver's License Number *

Do you have a veterinarian chosen? *

Yes

No

Which veterinarian do you plan to use? *

Do you have any current pets? *

Yes

No

Please tell us about your current pets. *

Please list the name and ID# of the dog/puppy you are interested in adopting (your 1st choice). *

Are there pets you'd be interested in as backups? * NoYes

2nd Choice: Please list the name and ID# of the dog/puppy that is your 2nd choice.

3rd Choice: Please list the name and ID# of the dog/puppy that is your 3rd choice.

4th Choice: Please list the name and ID# of the dog/puppy that is your 4th choice.

5th Choice: Please list the name and ID# of the dog/puppy that is your 5th choice.

6th Choice: Please list the name and ID# of the dog/puppy that is your 6th choice.

I have had a dog before. *

Yes

No

Currently

My dog needs to get along with children. *

Yes

No preference

My dog will mostly live *

Inside

Outside

Both

When I am not at home, my dog will be *

In a crate

Loose in the house

In the yard

OtherOther

My dog needs to be alone _____ hours per day. *

I prefer that my dog is *

High energy

Medium energy

Laid back

For exercise, my dog will *

Go on frequent runs/walks

Go on occasional walks

Play in a fenced yard

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