Untitled Document

Desired Dog:
Email Address:
Applicant Name:
Applicant Age:
Applicant Occupation:
Name, Age, Occupation of Spouse/Significant Other (If Applies):
Names/Ages of Children, if any:
Any other occupants in home:
Address:
Home Phone:
Work Phone:
Cell Phone:
Type of Dwelling:	House Condo Apt. Other
Do you own or rent?	Own Rent
If rent, do you have your landlord's permission to have a dog? (If Applies)	Yes No
Landlord's Name & Phone Number: (if applies)
What are your primary reasons for wanting a dog?	Companion for yourself For Children For other pet Watchdog Other
If you have children, please describe their previous experience with dogs:
If your children did not want a dog, would you be interested in adopting a dog for youself?	Yes No
If anyone in your household allergic to dogs?	Yes No
If so, Please describe:
Who is home during the day; what hours/days?
If your current relationship changed, who would the dog live with.
If a future relationship did not want the dog, would you return the dog to the rescue or find another solution? Please describe in detail what your plan would be:
Do you have other pets? (number, sex & age of each)
Are your pets spayed/neutered?	Yes No
Have you ever allowed an animal to breed?	Yes No
Is the person that will spend most of the day with the dog someone besides you?	Yes No
If so, will that person be able to come with you to meet the dog?	Yes No
Is there anybody home during the day? who?
What would their responsibilities be with the dog?
Where do your dogs sleep at night?
Where do your cats sleep at night?
Where do your current dogs spend most of their time?
Where do your current cats spend most of their time?
Do you use a dog walker?	Yes No
If yes, can we interview her/him?	Yes No
Approximately how many hours during the day will your dog be home alone?
How many days a week will the dog be home alone for these hours? Please provide as much detail about your schedule as possible:
Where will the dog be when left alone. Please describe, in detail, the area where the dog would be left alone.
If the dog is left alone for more than 5 hours, what would you provide?
what rooms are off limit to the dog?
Can the dog lay on the furniture?
Is the dog allowed on your bed?	Yes No
What outside areas are available to your dog? Please describe in detail.
Do you have a doggy door?	Yes No
Type of fencing:	Chain link Wood Block wall Other
Height of fencing:
Are there gates? If so, how many and how tall?
Does your gate have a lock? If not, are you willing to install a lock? If so, please describe:
Do you have an electric driveway gate?	Yes No
Who has access to your yard?	Gardener Poolman Housekeeper Other
Would the dog be allowed in the yard when gardeners, poolmen, etc. are present?	Yes No
Do you have a pool? If so, is it gated?
What is your preferred level of exercise with the dog?
When on vacation, who will care for the dog?
If you take the dog with you on vacation/weekends, please describe type of vacation/weekend.	Boating/sailing camping traveling visiting friends/family recreational vehicle/motorhome Snowboarding/ski Other
What brand of food would you feed the dog? Is it dry or canned?
How many times a day would you feed your dog?
Do you have a regular vet?	Yes No
Name, Phone Number, and Address of Vet:
Who will groom the dog & how often?
Would your dog wear a collar & tags?	Yes No
What information would your ID tag include?
Would you allow your dog a permanent collar with our rescue group's information?	Yes No
How would you rate your level of experience with owning a dog?	First Time Owner Beginner Intermediate Advanced Other
How would you discipline your dog if he/she misbehaved?
How would you train your dog?	Obedience Class Hit with a newspaper Firm Verbal Commands Clicker/hand Signals Other
How do you normally walk your dog?
When the dog is on a leash, I normally use:	Collar only Choke chain Harness Other
Are you willing to live with the hair on furniture, stains on rugs, a warm body in bed, and an animal that might be destructive at times?	Yes No
A dog can live to be 20 years old; are you able to make this long-term commitment?	Yes No
If your pet became ill, gets injured, needs surgery, needs ongoing medical care, etc. What is your monetary limit for the needed veterinary/medical care?
What would happen if you moved? (Locally, Out of state, Out of country)
If you are a renter and encounter difficulties with your landlord or have to leave your current rental for any other reason what will you do? If you have trouble finding a pet friendly rental, what will you do?
Have you ever given a pet away?	Yes No
If yes, please explain why:
What would prompt you to return the dog to the Mutt Connection?	Excessive barking Digging Biting Moving Divorce Poor Watchdog Destructive Chewing Financial Problems Accidents Indoors Growling at Guests Excessive Bills Shedding Allergies New Spouse/Partner Doesn't Like the Dog Aggressive on Leash Divorce None of the Above
If your dog became sick, would you return him/her to the Mutt Connection?	Yes No
Will you agree to consult and pay for a trainer or behaviorist if any problems develop?	Yes No
I understand that the going rate of such training at your home is approximately $150 per session (or more):	I understand I disagree
Have you ever been denied adoption by another rescue?	Yes No
Please list pets you have owned as an adult, length of ownership and what happened to them.
Please explain why you are interested in adopting a rescue dog:
I understand that a home visit is REQUIRED prior to final placement.	I agree I disagree
I understand that my dog must walk on leash at all times and that he/she must be walked on a harness, soft fabric slip collar, or choke chain. Walking my dog on ID collar puts the dog in unnecessary danger and I agree I will not do so under any circumstance	I agree I disagree
I understand that any contribution given is a gift given freely, not a purchase price for the dog.	I agree I disagree
Can you make at least a $300(adult dogs) or $375(for puppies) contribution to help rescue, provide medical care, spay & neuter, board and place other abandoned dogs?	I am willing I am not willing
The rescue reserves the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract.	I agree I disagree