|
Name:
|
|
| Address: |
|
|
Telephone Numbers: |
Home |
Work |
Cell
|
|
| E-mail address:
|
|
| Best way to
contact you: |
Home Phone
Work Phone
Cell Phone
E-mail
|
| Best time
to contact you: |
|
| Why
have you decided to adopt a dog?
|
| If
you are interested in adopting a particular FCHS dog or dogs,
what is his/her/their name(s)?
|
| Why
did you choose this/these particular dog(s)?
|
| If
you have not yet chosen a dog, what type of dog are you looking
for?
|
|
Companion for: (check all that apply) |
|
Myself/family
Another pet
Friend or relative
Other
|
|
Are you over 18? |
Yes
No |
|
HOME ENVIRONMENT
|
| Number
of adults, including yourself, at home:
|
|
|
Number of children at home: |
|
| Please list the
names of all people, including yourself, living at home, and
the ages of those under 18, and whether they agree with getting
a new cat. |
| Name:
Age:
Agrees
Disagrees |
| Name:
Age:
Agrees
Disagrees |
| Name:
Age:
Agrees
Disagrees |
| Name:
Age:
Agrees
Disagrees |
| Name:
Age:
Agrees
Disagrees |
| Name:
Age:
Agrees
Disagrees |
| Name:
Age:
Agrees
Disagrees |
|
Do you own or rent your home? |
Own
Rent
|
|
If
owner:
Single Family
Condo/Townhouse
Other
|
If
renter:
Apartment
Mobile Home
Other
Does your lease allow dogs?
Yes
No
If yes, what is the weight limit?
Does your lease contain specific
breed limitations or restrictions?
|
| |
Landlord's
Name:
Landlord's Phone:
|
Do
you have a fenced yard?
Yes
No
|
| If
yes, please describe your fenced yard.
|
|
DOG SPECIFIC INFORMATION
|
|
Where will your dog spend the majority of the time? |
Indoor Only
Mostly Indoor
Indoor/Outdoor
Outdoor only
|
| How
many hours a day will your dog be left alone during the day?
|
| Where
will your dog be kept when alone?
|
| Where
will your dog sleep?
|
| How
will you encourage and reinforce appropriate behavior?
|
| How
will you prevent/manage inappropriate behavior?
|
| How
do you plan on training your dog?
|
| If
you go away for a few days, or on vacation, who will take care
of your dog?
|
| What
will you do with your dog if you have to move?
|
|
Does anyone in your family have allergies to dander or hair
? |
Yes
No
|
| Owning
a dog is a serious financial responsibility. Are you prepared
financially to spend a MINIMUM of $200 per year for veterinary
care, (including routine vaccinations, heartworm preventative
medication and flea/tick preventative medication), food and
expenses? |
Yes
No
|
| A
well-cared for dog may live 12 years or more. Does your lifestyle,
career and family plans allow you to make this commitment? |
Yes
No |
| Under
what circumstances would you return the dog to the Franklin
County Humane Society?
|
|
PET OWNERSHIP
|
| Please
list all the companion animals you have had as an adult. If
you have had more than five, list the five most recent.
|
| |
Have you ever had to give up a pet for any reason? |
Yes
No
|
If yes, what happened
to the pet?
|
|
INFORMATION ABOUT YOUR
VET
|
| Veterinarian's
Name: |
|
| Veterinarian's
Phone Number: |
|
| Name
of Veterinarian's Practice : |
|
May
we contact your vet for a reference? |
Yes
No |
|
REFERENCES
|
| Please list two
references.
|
Name:
|
|
Phone
Number: |
|
Address:
|
|
Name:
|
|
Phone
Number: |
|
Address:
|
|
