1. Will the animal live at the address listed above?
Yes
No |
2. Are you under 18 years of age?
Yes
No |
3. How long have you lived at the above address?
|
4. This address is a:
|
5. Do you:
|
6. If you live in an apartment complex, please
provide the name of the complex:
|
7. If you rent, do you have the landlord/manager's
permission to have a pet?
Yes
No |
8. If yes to above, what is the name and phone
number of manager/landlord?
Name:
Phone: |
9. Are you aware of the license, leash and animal
laws of the community?
Yes
No |
10. How many adults live in your household?
|
11. Do they all want a pet?
Yes
No |
12. Will there be an adult home during the day?
Yes
No Part-time |
| 13. If no or part-time, how many hours will the pet
be home alone each day?
hours. |
14. Who will be their primary caregiver of the pet?
|
| 15. How many children live in the home?
Please give their ages: |
16. Are you interested in adopting for yourself,
family or someone else?
Myself
Family
Someone Else |
17. Do you or does anyone else in the family have
allergies to animals?
Yes
No |
18. Are you employed?
Yes
No
Where?
How long? |
19. What is your work phone number?
|
20. Do you or your spouse have jobs that require
relocation?
Yes
No |
21. If so, how often do you relocate?
|
22. If you relocate, what will you do with your new
pet?
|
23. Are you aware that a pet is a large and lifelong
commitment?
Yes
No |
24. Name of Animal you are interested in.
|
25. How many hours of socialization a day does this
pet need?
|
26. What activity level do you think this pet will
have once he/she is an adult?
Low Moderate
High |
27. How do you plan to exercise your new pet?
|
28. If the animal you are considering adopting is a
puppy, do you think he/she will grown into a:
Small
Medium Large
adult dog?
|
29. Puppy training takes a lot of time and energy.
Who will be primarily responsible for the training?
|
30. List some of the problems associated with
raising a puppy.
|
| 31. It may take your new pet a month or longer to
adjust to its new home. Are you prepared to allow this much time?
Yes No
Concerns?
|
32. As a potential new pet owner, what behaviors are
you not willing to tolerate from a pet?
|
33. What will you do to correct the behaviors you
have just listed?
|
34. What could happen to this animal if you do not:
a. Keep its vaccinations
current?
b. Give it heartworm
preventative?
c. Give it flea and tick
preventative?
d. Deworm it?
e. Groom it? |
35. Please click on any of the following reasons for
adopting this pet:
If other please explain: |
36. Is your fence or backyard fully fenced?
Yes
No |
| 37. Of what material is the fencing made? If you do
not have a fenced yard, how will you provide for the safety of
your new family pet? |
38. Type of street you live on:
|
39. Do you have acreage?
Yes
No
If so, how much?
acres. |
40. Can you provide a doghouse of sufficient shelter
to adequately prevent the animal from the heat, cold, rain?
Yes
No Please
explain |
41. Where will your new pet live?
|
42. Where will your new pet stay when no one is at
home?
|
| 43. How many hours a day will your new pet spend
alone? |
44. How will your animal be cared for when you leave
town?
|
45. Have you ever adopted a pet from GHHS or another
humane society?
Yes
No Please
explain: |
| 46. How many pets do you have now? |
47. Are they all spayed or neutered?
Yes
No |
48. Are they current on all their vaccinations?
Yes
No |
49. What are their names and breeds?
|
50. Under which veterinarian's practice(s) have
these animals received their care? Please give veterinarians'
name(s) or clinic's name along with phone number.
|
| 51. On the average, how much do you spend yearly on
the care? (medical/vaccinations/heartworm preventatives, flea
control, food) for each of your pets? |
52. We verify previous veterinary histories. Do you
mind if we check with your veterinarians?
Yes
No |
53. Please give history of previously owned (no
longer living in the home) pets and what happened to them:
|
| 54. Did any of the previous pets die of Parvo,
Distemper, Panleukopenis, FIV, FeLv or an unknown disease in the
past 12 months? Yes
No |
55. If so, where did these animals live?
Indoors
Outdoors
Both |
| Your application will not be processed without a
veterinarian reference from a clinic that you have used and that
can verify the treatment that your past and present pets have
received. |
56. Have you ever turned an animal in to a humane
society, animal control (pound) or euthanized an animal?
Yes
No
Please explain:
|
| Do you realize that: |
| 57. If your pet is not provided with the appropriate
attention and affection, he/she may experience loneliness,
boredom, frustration, depression, etc.. This may translate into
your pet's destructive behavior such as inappropriate chewing,
barking, digging, aggression, etc. Yes
No |
58. Young children should not be left unsupervised
with any animal?
Yes
No |
| 59. Proper pet care includes planning and providing
for your pet's needs. This includes puppy-proofing your home,
making kennel reservations when you plan your family vacation,
visiting the veterinarian if your pet acts unusual, scheduling an
annual exam BEFORE the rabies vaccine expires, etc. Yes
No |
60. We make a home visit prior to placing dogs. Do
you mind if we visit you at home before adoption?
Yes
No
Please list convenient days
and times: |
| FOR CATS ONLY: |
61. Will the cat live inside exclusively?
Yes
No |
62. Will it be declawed?
Yes
No |
| *** In cases where several people are interested
in the same pet, we will select the home that we believe is best
suited to meet the needs of the pet.*** |