Dog Adoption Questionnaire

Please fill out the following questionnaire and click "Send" at the bottom to submit it. If you have not heard back from us within 2-3 days (not including weekends) please email us again or call our office at (209) 365-0535 between the hours of 1 PM and 7 PM week days. If you do not hear from us please do not take it personal. Sometimes we actually may not have received your application and other times it's a matter of being accidently overlooked.

Some questions have small  ""  icons next to them; you can move your mouse over these icons to display brief descriptions and clarifications for the questions. If a tip gets in your way, just click it to dismiss it.

1) Tell us how to get in touch with you
Street Address: 
Preferred: Personal    Work
Day: () -
Evening: () -
Cell: () -
Preferred: Day    Evening    Cell

2) Distance from Lodi, CA: 

3) Name of Pet you are interested in or Breed: 

4) Where did you find us? 

5) Do you rent or own your home?
Rent    Own
If you rent, how long have you lived there?
If you have been renting your current place less than one year, where did you live previously?
Street Address: 

6) If you rent, you will need to get landlord approval.
Landlord name:
Landlord phone number: () -

7) Do you live with your parents?
Yes    No

8) Have you ever adopted a pet before?
Yes    No
From where?

9) Why do you want to adopt a pet?

10) Why would you like to adopt this pet? 

11) Do you currently have any pets living with you?
Yes    No
If yes, describe the pets currently living with you: 

12) Are all pets in your home current on vaccinations?
Yes    No

13) Have you had other pets in the last five years?
Yes    No

14) Were any hit by cars at your present address?
Yes    No

15) Was a pet ever given away?
Yes    No
If Yes, Why?
Could this be a problem, again?
Yes    No

16) How many children are in the home?
What are the ages of the children? (please check all that apply)
0-4    5-8    9-13    14+

17) Do children frequently visit your home?
Yes    No

18) Will your pet live indoors or outdoors or a combination of both?

19) Where will the pet sleep? 

20) Do you have a completely secure fenced yard? 
Yes    No
Describe your fence & area for your pet: 

21) Who will care for your pet when you are away? 

22) On a regular basis, how long will the pet be left alone? 

23) What provisions will you make for the pet if you are no longer able to care for it? 

24) Can you afford the following: (check all that apply)
pet food   veterinary care   professional grooming

25) Will you maintain a schedule for the following: (check all that apply)
brushing    bathing    flea control   professional groomer

26) Do you have a regular veterinarian?
Yes    No
If yes, please give their name and phone number:
Phone number: () -

27) Is anyone in your home allergic to pets?
Yes    No

28) Do you have any unaltered pets in the home?
Yes    No
If yes, Why?

29) Is everyone in your home willing to make a LIFETIME commitment to this animal? (Pets can live 12-18 years!)
Yes    No

30) Have you ever had a dog or puppy before?
Yes    No

31) What do you know about this breed of dog? 

32) Most of the time it will take several weeks or longer for your new animal and you to adjust to each other. Are you willing to allow this time?
Yes    No

33) Dogs sometimes need training (i.e.: house training, leash training, jumping, etc.) Will you be able to handle this?
Yes    No

34) Frequently you will encounter behavior problems like digging, chewing, jumping. How will you deal with this? 

Additional comments:


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