Dog  Pre-Adoption Form

Please complete this questionnaire and send/bring it to:

                                      New Rochelle Humane Society
                                                70 Portman Road
                                           New Rochelle, N.Y. l080l

By answering these questions prior to visiting the shelter, it will speed up the adoption process and help us to match you with the most appropriate pet. These forms will also enable us to contact you at another time if we are unsuccessful in making a match today. 

Name of dog you are interested in adopting:

YOUR NAME:

ADDRESS:

CITY:  STATE:

ZIP:   E-MAIL

PHONE: Daytime:
                 Evening:

HOW LONG AT THIS CURRENT ADDRESS?

HOW LONG WILL YOU BE STAYING AT THIS ADDRESS?

DO YOU WORK ?    WHAT ARE YOUR HOURS?

OCCUPATION:  

EMPLOYER:

ADDRESS: PHONE:

CITY STATE ZIP

DOES YOUR SPOUSE WORK?

WHAT ARE HIS/HER  HOURS?

WHO IS PET FOR? Self Gift For Whom?

ADOPTOR'S AGE 

DO YOU LIVE ALONE?

LIST OTHER PEOPLE LIVING IN YOUR HOME:

NAME RELATION

NAME RELATION

NAME RELATION

NAME RELATION

WHO WILL BE RESPONSIBLE FOR THIS PET?

CHECK ALL THAT APPLY:

DO YOU:        RENT?           OWN?

HOUSE?     CONDO?       APT?          CO-OP?

PRIVATE  YARD?        IS THE YARD FENCED?

IS THE YARD SECURELY FENCED FOR A DOG?

ARE THERE CHILDREN LIVING IN HOME?

AGES:

ARE THERE CHILDREN THAT LIVE NEARBY OR VISIT?

AGES

DO YOU HAVE OTHER PETS NOW?

CURRENT PETS

PET’S NAME: BREED :

NAME OF VETERINARIAN USED FOR THIS PET 

PET’S NAME: BREED:

NAME OF VETERINARIAN USED FOR THIS PET.

LIST ANY PET OWNED IN THE PAST 10 YEARS

PET’S NAME:  BREED:

VET USED:

Explain why:

PET’S NAME:  BREED:

VET USED:

WAS THIS A PET THAT WORKED OUT WELL WITH YOUR FAMILY?

Explain why:

LIST ANY ACTIVITIES THAT YOU ENJOY IN WHICH YOU WOULD LIKE TO INCLUDE YOUR DOG

WHERE WILL THIS DOG SPEND MOST OF THE DAY?

CRATE:   FREE RUN OF HOME:  ONE OR TWO ROOMS  BASEMENT

IF OUTDOORS, WILL THE DOG BE:

TIED?  FENCED?  ELECTRIC FENCED?   KENNEL RUN?

WHAT WILL YOU DO IF YOUR DOG IS DESTRUCTIVE WHEN LEFT ALONE?

HOW WILL YOU EXERCISE YOUR DOG?

ARE YOU WILLING TO ATTEND TRAINING CLASSES IF NEEDED?

HAVE YOU EVER TRAINED A DOG BEFORE?

LIST TYPES OF BEHAVIOR THAT YOU CONSIDER NOT ACCEPTABLE

PLEASE LIST THREE PERSONAL REFERENCES :

NAME                                             PHONE                                   YEARS KNOWN

IS THERE ANYTHING ELSE YOU WOULD LIKE US TO KNOW?