Animal Connections

Name of Primary Caregiver:

Name of Secondary Caregiver:

Phone Number (H) (W)

Email

Address Apartment Number

City State Zip

occupation

Name of the dog of interest

Number of adults in household 1 2 3 4 5+

Do all adults work outside of home? No Yes

Number of children 0 1 2 3 4 5+

Ages of Children (separate with comma):

Do children frequently visit? No Yes

does any family member have severe pet alergies No Yes, cats only Yes, dogs only Yes, cats and dogs

is any family member nervous around animals No Yes

do you own or rent? Own Rent Neither

If rent, do they allow pets? Yes No

Landlord Name Number

Home is located in the City Country Suburbs Trailer

Would you allow a home visit? Yes No

List Current Pets

Have you ever had any other pets last 5 years? 0 1 2 3 4 5+

Where are they now?

Do you have a vet? Yes No

If yes, name: and Phone

What type of dog are you looking for?

Age: No Preference Pupply Young Adult Adult Senior

Size: No Preference Toy (below 7lb) Small (7-25lb) Medium (25-50lb) Large (50-80lb) X-Large (80lb+)

Sex: No Preference Male Female

Spay/Neutered: No Preference Before Adopting After Adopting Do not want fixed

Reason for adopting dog?

Energy Level: No Preference High Average Low

What is necessary to you in a dog you will adopt?

Do you plan to take the pet to obedience class? Unsure Yes No

Are you prepared to spend $300-$500 per year on expenses? Yes No

Where will your dog be kept? Primarily Indoors Primarily Outdoors Indoors and Outdoors

How many hours will the pet be left alone per day? 0-3 hours 4-7 hours 8-12 hours +12 hours

Where will the pet stay during these times?

What form of exercise will the pet recieve? None Leash Walk Fenced Yard Dog Park Other

If you have a fenced yard, what type? N/A Regular chain/wood Electric Invisible Open Land Other

What reasons would you give up a pet?

Have you ever surrendered a pet? No Yes

Explain:

List two references