BASIC INFORMATION

Please fill out your contact information.

Date: *

Dog's Name *

First Name *

Last Name *

Home Phone *

Cell Phone (if different)

Email Address *

Street Address *

Apartment, suite, etc

City

Province

ZIP / Postal Code

Country

Personal Reference Name (not a family member) *

How long have you known each other? *

Reference Phone Number *

Relationship to You *0 / 100

QUESTIONNAIRE

Please complete the following questionnaire in its entirety. Our main objective is to ensure good compatibility between you, your family, and your new pet.

Do you own or rent your residence? *OwnRent

If you rent, do you have your landlord's permission to have a dog?YesNo

Landlord's Name & Phone Number0 / 100

If you answered other, please explain:0 / 100

Has everyone in the household met this dog *YesNo

Is this going to be your first dog? *YesNo

Where did your previous dog spend their time?IndoorOutdoorIndoor & Outdoor

If this is not your first dog, what happened to your previous dog?

If you selected other, please describe:

Do you have a regular veterinarian? *YesNo

If yes, please provide vet's name and phone number:

Who will be the primary caregiver of the dog?

Are you 25 years of age or over? *YesNo

What is your occupation? *

Do you have reliable transportation? *YesNo

Are all family members in agreement about adopting a dog? *YesNo

How many people reside in your home? *

Are there any children residing in your household? *YesNo

If yes, how many children?

What ages are the children?

Does any family member suffer from allergies? *YesNo

Is yes, what type of allergy?

Do you currently own any other animals (including livestock)? *YesNo

If yes, please list the animals, along with their name and age:

Are they spayed or neutered?YesNo

If you have other pets, how do you feel they will adjust to a new dog in the house?

Do you have a fully-fenced yard? *YesNo

If yes, what is the height and type of fence?

Do you have a separate kennel run? *YesNo

If yes, list height and size:

If yes, is there a dog house in the run? *YesNo

If yes, how often will you use this run?

On average, how many hours a day will the dog be left alone? *

If other, please describe:

Basement

If you answered BASEMENT to any of the above questions, please answer the following three questions:.

How do you plan to exercise your dog and see to its toilet needs? *

How much time per day can you commit to exercise your dog? *

What will you feed this dog? *Dry foodWet foodRaw foodOther

How much do you expect the cost to be monthly? *

Have you considered the financial responsibilities of owning a dog? *YesNo

Do you feel you can commit to a dog for the next 10 to 20 years? *YesNo

If you were to go on vacation, where would the dog stay? *

If you were to move in the future, what would happen to the dog? *

Are you willing to take this dog to positive-method obedience classes? *YesNo

Are you able to provide proper medical care for your dog as required? *YesNo

Are you in agreement with the rule that if you can no longer keep the dog, you are required to return it to RAPS? *YesNo

Have you ever surrendered or rehomed an animal? *YesNo

What would the number one reason for you to return the dog? *

What is your opinion of using a crate for training purposes? *

Your dog refuses to obey a command. How would you handle this? *

If you returned home to find that you dog has chewed your furniture what would you do? *

If your dog urinated/defecated on the floor what would you do? *

FINAL STEPS

Only applicants chosen for adoption will be contacted. RAPS reserves the right to refuse any applicant.

RAPS is concerned for the well-being of all shelter dogs. Would you be willing to allow one of our staff members to do a scheduled home visit prior to, and/or after the adoption process in necessary? *YesNo

If no, please explain:

I certify that all the information I have provided is true and correct: *YesNo

“Donut” (above) & “Blossom” (below), photo sby Michele Wright, Furry Friends Photography

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