PRE
ADOPTION QUESTIONNAIRE |
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| Name |
First
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Middle
Init |
Last
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| Address |
Street |
City |
State |
Zip |
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| Permanent
Address (if different from above) |
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Street |
City |
State |
Zip |
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Phone |
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Evening
Phone |
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| Email
Address |
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| Landlord
or Apt Complex Name |
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| Landlord
or Apt Complex Phone |
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| How
did you hear about the San Diego Humane Society and SPCA? |
TV |
Paper |
Website |
Family/Friend |
Radio |
Yellow
Pages |
Other |
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Please check all appropriate boxes that apply AND provide any
explanation as necessary.
I
want this animal for: |
Breeder |
For
Child |
Gift |
Family
Pet |
Working/Farm |
Companion
for Pet |
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| Protection
for home (explain below) |
Protection
for business (explain below) |
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| Do
all the members of the household want a new pet? Y
N
(if no please explain) |
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| How
many adults are in the household?
Children?
Children Ages
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| Are
you over 18 years of age? Y
N
if no please explain: |
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| Do
any members of the household have allergies specific to animals?
Y
N
If yes, please explain |
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| Veterinarians
Name or Practice Name |
Phone
Number |
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May
we phone your veterinarian for a reference?
Y
N
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if
no, please explain
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| Please
list your current pets residing at your home (include any other
roommates pets as well) |
Breed/Type |
Age |
Sex |
Altered |
#
years owned |
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Y
N
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Y
N
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Y
N
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Y
N
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Y
N
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| Have
you owned any pets in the last five years not listed as current?
Y
N
if yes please explain: |
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| Can
the veterinarian verify vaccination history on current or past pets?
Y
N
if no, please explain: |
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| Have
you relinquished any pets before? Y
N
if yes, please explain including whom, why and when: |
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| Where
would your new pet be kept when your at home? |
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| Where
would your new pet be kept when you are NOT at home? |
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| If
kept outdoors explian how your bet would be confined? |
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might be Zip Line, chain, fence (please give a full description
of type and height of fencing) |
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| Total
length of time?
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Type
of shelter?
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Type
of shade?
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| In
a 24-hour day how long would the pet be left alone at any given
time? |
<4
hours
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4-8
hours
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8-12
hours
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>12
hours
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| Given
the possiblity of housebreaking difficulties, please describe your
expectations on this tedious and sometimes very frustrating task:
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| Who
would ultimately be responsible for the socialization and training
needs of your new pet? |
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| Remembering
you are applying for a lifetime companion, are you willing to make
the investment in both time and finances (up to $1000 annually)
to care for an properly manage your new pet? Y
N
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Would
you be willing to allow a representative to make a home visit
at a mutually agreed upon time?
Y
N
if no please explain:
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| Would
you like to receive updated information about upcoming SDHS programs
and events including dog classes? Y
N
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| We
hope you have thoughtfully considered each of the questions asked.
Once again, the adoption of a life-long animal friend should not
be impulsive, but rather a carefully made decision which will ensure
a loving, lasting relationship. |
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Thank
you for taking the time to
complete this application!!
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