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Dog Adoption Survey
Thank you for your interest in adopting! Please complete this form and submit it, and we will be in touch soon to discuss next steps in the adoption process. Please note that completing this interest form does not guarantee you're first in line nor does it guarantee any specific animal will approved for adoption. We look forward to helping you find a good match for your home!
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Today's date
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MM
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Full Name
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Your answer
Legally, adopters must be 18 years or older. Are you 18 years or older?
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YES
NO (someone 18 years or older must complete this form instead)
Required
Physical Address : City : State : Zip Code
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Your answer
Mailing Address : City : State : Zip Code
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Your answer
Primary Phone Number
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Your answer
Email Address
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Your answer
The following questions will help us determine if the animal you are interested in is potentially a good match for you and for the animal. Please be as descriptive as possible.
If you are interested in in a specific dog, what is their name?
Your answer
Have you ever owned a dog before?
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Yes
No
If you currently have other animals at home, please list all of them here.
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Your answer
Please list all people who live in your home, including their ages.
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Your answer
What is the most important quality that your new dog needs to have (i.e. needs to be good with kids or needs to be easy to walk)?
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Your answer
What type of energy level are you looking for in a dog?
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High Energy
Moderate Energy
Low Energy
How much training are you comfortable with (none, basics, obedience, agility, etc.)?
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Your answer
What type of training do you currently use for your dogs or plan to use with your new dog?
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Your answer
What types of behavioral issues have you dealt with in your experience with dogs (mouthy, house breaking, separation anxiety, etc.)? Please explain.
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Your answer
How do you plan to exercise your dog?
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Your answer
If your yard is fenced, what type of fence do you have?
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Your answer
Are you looking for a dog that is okay with being left alone in the home when you are away?
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Your answer
How important is it that your dog can be off leash outside?
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Not Important
1
2
3
4
5
Very Important
How important is it that your new dog is friendly with other dogs?
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Not Important
1
2
3
4
5
Very Important
How important is it that your new dog is friendly with cats?
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Not Important
1
2
3
4
5
Very Important
How important is it that your new dog is friendly with small animals or farm animals?
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Not Important
1
2
3
4
5
Very Important
How important is it that your new dog is friendly with children?
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Not Important
1
2
3
4
5
Very Important
How important is it that your new dog is friendly with teenagers?
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Not Important
1
2
3
4
5
Very Important
What type of neighborhood to you live in (busy roads/woods, kids, dogs running around, etc.)?
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Your answer
Please describe your home environment/lifestyle (active, frequent traveler, work from home, lots of foot traffic, etc.).
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Your answer
Sometimes we get animals that need to be on special diets or daily medications/supplements. Is this something of importance to you when adopting?
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Your answer
On average it takes about 3 months before a newly adopted dog is comfortable and has adjusted to its new home. Is an adjustment period time frame something of importance to you when adopting?
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Your answer
Is there any additional information you would like us to know?
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Your answer
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This form was created inside of Upper Valley Humane Society.
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