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ADOPTION
QUESTIONNAIRE
2480 Millville-Ross Rd
Hamilton, OH 45013
513) 737-7387
Name:____________________________________________Today’s
Date:_________________
Address:________________________________________Phone
number:___________________
City:_______________________ State:_______________ Zip
Code___________________
Email address:______________________________________________________
List everyone that lives in your household and the ages of any
children in the home_____________
________________________________________________________________________________
List a reference: Name______________________________
Phone:_________________________
How long have you been considering adopting a
pet?___________________________________
Is this pet going to be a gift? YES NO For
whom?_________________________________
Have you or anyone in your family adopted from the
AAF?_________________________
Have you or anyone in your family surrendered an animal to the AAF?
_________________
What kind of pet are you looking for: (check all that apply)
□ Family □ Personal companion
□ Companion for another pet
□ Breeding □
Protection □ Hunting
□ Farm work □ Barn/mousing
cat □ Show/Competition
□ Other_________
Where would a pet stay/sleep at your home? (check all that apply)
□ Inside □
Outside □ Undecided if outside or inside
□ Crated inside □
Barn □ Full run of the house
□ Garage/Basement □ Outdoor
kennel □ Tied outside
□ Other:_________
Approximately how many hours would this pet be home
alone?_______________
Do you: □ Rent □ Own
Do you have proof of ownership or your lease agreement with you
today? _________
Landlord’s name:__________________ Landlord phone
number:______________________
YOUR
CURRENT PETS
List the pets that currently live in your home:
______________________________________________________________________________
Where are they kept/where do they
sleep?____________________________________________
Vet’s name________________________________ Vet’s Phone #
______________________
Are they current on vaccines? □ Yes □ No
Are they spayed or neutered? □ Yes □ No
Are they on heartworm prevention? □ Yes □ No If
not, explain.________________
During which months of the
year?_____________________________________
What type of prevention is
it?_________________________________________
PAST PET EXPERIENCE
List your previous
pets:__________________________________________________________
Where were they kept?/Where did they
sleep?________________________________________
Were they spayed/neutered? □Yes □No
Where are they now:
If given up, why? □ Behavior □ Allergies □
Moving □ Other________________
If deceased, why? □ Illness □ Accident □
Euthanasia
Ran away/ lost? What
happened?___________________________________________
YOUR EXPECTATIONS
Are you aware that the
average annual expense for a dog is $750.00 and a cat is $670.00?
□ Yes
□ No
What do you consider unacceptable behavior:
□ Excessive barking □ Digging in yard □
Chewing/scratching furniture
□ Jumping on people □ Pulling on leash
□ Urinating/defecating in house
□ Other:___________
What methods would you use to prevent/correct these behaviors?
______________________
If you are adopting a dog, do you plan to attend obedience training?
___________
Which of the following circumstances would cause you to bring a
dog/cat back to the shelter?
□ Chewing □
Jumping □ Running away from home
□ Excessive barking □ Digging in
yard □ Hard to walk on leash – very strong
□ Not enough time □ Pregnancy/new
baby □ Change in marital status
□ Too expensive □ Animal is
sick □ Not interested anymore
□ Moving □
Allergies □ Not getting along with kids
□ Refusing to use litter box □ Not getting along
with other animals |