Date:                                                               Name of Desired Dog:

Your Name:                                  Occupation:

Spouse's Name:                            Occupation:

Names and Ages of Children:

Any other occupants in the home?

 

Home Address

Street:

City:

Province:

Postal/Zip Code:

 

Contact Info

Daytime Phone:

Evening Phone:

Email:

 

Type of Dwelling

House Apartment Town Home Other

If other, please specify:

Do you rent or own?

If you rent, do you have your landlord's permission to have a dog? Yes No

Landlord's name & phone number:

If you own an apartment, do you have the strata corporation’s permission to have a dog? Yes No

Strata corporation's phone number:

 

Reasons for wanting a dog

Companion for you Companion for kids Companion for other pet Watchdog Gift Other

If other, please specify:

Does anyone in your family have allergies?

Do you have a pet now? Yes No

How many?

Type of pet:

If dog, please list breed:

Age(s) & Sex(es)

Are you pets spayed or netuered? Yes No

Are your pets current for all vaccinations? Yes No

Have you ever allowed an animal to breed? Yes No

Have you ever euthanized a pet? Yes No

If yes, please explain:

Have you ever been convicted of abuse or neglect of a child or an animal? Yes No

Have you ever surrendered a pet to a shelter? Yes No

If yes, please explain:

 

Where will the dog stay?

When home alone: Run ofHouse Crate Specific Room Garage Other

In another room or other please explain where:

Sleep at night: Run of House Crate Your Bed Garage Dog Bed Other

In dog bed or other please explain where:

Is there anyone home during the day? If so, who?

How many hours per day will the dog be left alone?

When will the dog be outside?

When will the dog be inside?

What rooms are off limits to the dog?

What outside areas are available to the dog?

Fenced Yard Enclosed Patio Garage Balcony Unfenced Area Other

If other, please specify:

 

Access to yard

Gardener Pool Maintenance Utility Neighbour Other

If other, please specify:

Do you have a doggie door? Yes No

Where does it lead to?

Type of fencing?

Height of fence?

Are there gates? How many?

Type of locks?

I have recently inspected my fence and it is in good condition: Yes No

Preferred level of exercise: Couch Potato Short Walks Vigorous Walks Hiking or Jogging

How will you normally walk the dog: on-leash, off-leash, or both?

 

Collar

Will the dog wear a collar? When?

What type of collar?

Collar Harness/Halti Choke Chain Other

If other, please specify:

 

Level of Dog Owning Experience

First Time Beginner Intermediate Advanced Other If other, please specify:

What kind of food will you feed the dog?

Brand:

If adopting a foster dog, will you continue to feed the top quality dog food The Penny Foundation uses? Yes No

Do you have a regular vet? Yes No

Name:

Would you like a referral to a vet? Yes No

Who will groom and bathe the dog?

Please list the dogs you have owned as an adult, the length of ownership, and if no longer with you, please explain why.

 

Training

How will you discipline the dog when it misbehaves?

Obediance Classes Clicker Training Firm Verbal Hand Signals Hit With Newspaper Other

If other, please specify:

 

3rd party care

When you go on vacation who will take care of the dog?

What will happen to your pet if you move?

Out of province?

Out of state?

 

Reasons you might give up your dog

Excessive Barking Biting Digging Moving Divorce Poor Watchdog Destructive Chewing Financial Problems Accidents Indoors Growling at Guests Excessive Vet Bills Shedding Allergies New Spouse/Partner doesn't like Dog Agressive on leash None of the Above Other

How did you hear about our adoption program?

Why are you interested in adopting a rescue?

Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at times?

Yes No

Pets are an investment of your time and money. Can you afford to provide veterinary care, grooming, proper diet, shelter, and exercise for your new pet?

Yes No

Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as much as 10 to 20 years?

Yes No

Please tell us why you are interested in this particular dog.

 

Terms and Conditions

I understand that a home visit is required prior to final placement.

I understand that a home visit does not guarantee placement.

I CAN make a donation of at least $350 to help rescue, provide medical care, spay and neuter, board and place other abandoned dogs. I understand that any donation or contribution is a gift freely given, not a purchase price for a dog.

Yes No

I agree to provide my own collar, leash, dog permit, and personal ID at the time of completing the adoption contract.

The Penny Foundation reserves the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract.

 

I have read and accept the terms and conditons

No Yes

 

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