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Dog Adoption Questionnaire
Please fill out this questionnaire to the best of your ability.
Date
*
/
/
(mm/dd/yyyy)
First Name
*
Last Name
*
Street Address
*
Suite/ Apt #
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavat Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip
*
Email
*
Phone
*
Is there a particular dog that you are interesting in adopting:
Yes
No
If YES, what is the dogs name and give a brief description:
If NO, tell us about your ideal pet (personality, size, breed, age, etc.):
Tell us about your pet ownership history and current pets (specifics, sex, age, health challenges, etc.):
Tell us about the members of the new pets household (number of adults and children, ages, allergies, etc.):
Tell us about your home:
I would like to learn more about:
Spaying and neutering
Vaccinations
House-training techniques
Grooming
Socializing this pet with others
Heartworm prevention
Local veterinarians
Creating a pet emergency plan
How to best care for my pet
What to feed my pet
Health challenges
The average lifespan of a dog
Other questions/comments:
I certify that the above information is true. I also understand that giving false information on this application is grounds for denying an adoption.
*
Yes
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