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P.E.T.S DOG ADOPTION QUESTIONNAIRE
*DOGS NAME OF INTEREST
*BREED OF DOG/COLOR
*WHERE DID YOU FIRST HEAR ABOUT THIS DOG?
Choose a WHERE DID YOU FIRST HEAR ABOUT THIS DOG?
PETFINDER
SOCIAL MEDIA (FACEBOOK)
PETCO
PETSMART
FRIEND/FAMILY
OTHER
*YOUR FIRST NAME
*YOUR LAST NAME
*ADDRESS
*CITY
*STATE
*ZIP CODE
*COUNTY LIVING IN
EXAMPLE-POLK DALLAS GUTHRIE
*PHONE NUMBER
*EMAIL ADDRESS
*HAVE YOU ADOPTED FROM US IN THE PAST?
Choose a HAVE YOU ADOPTED FROM US IN THE PAST?
YES
NO
IF YES TO THE ABOVE, TYPE OF ANIMAL/NAME AND DATE OF ADOPTION
*ARE YOU EMPLOYED?
Choose a ARE YOU EMPLOYED?
YES
NO
STUDENT
RETIRED
OTHER
PLACE OF EMPLOYMENT
PLEASE ENTER THE INFORMATION BELOW ENTIRELY. PLEASE NOTE THAT WE WILL VERIFY HOME OWNERSHIP OR CHECK WITH YOUR LANDLORD PRIOR TO ANY MEET/GREETS WITH ANIMALS. IF YOU RENT YOU MUST PROVIDE YOUR LANDLORD INFORMATION. FAILURE TO PROVIDE YOUR LANDLORD INFORMATION WILL RESULT IN THE APPLICATION NOT BEING PROCESSED. THANKS SO MUCH FOR YOUR UNDERSTANDING.
*TYPE OF RESIDENCE?
Choose a TYPE OF RESIDENCE?
HOUSE
CONDO
APARTMENT
MOBILE HOME
OTHER
*DO YOU OWN OR RENT?
Choose a DO YOU OWN OR RENT?
OWN
RENT
*RENTERS: DOES YOUR LANDLORD ALLOW PETS?
Choose a RENTERS DOES YOUR LANDLORD ALLOW PETS?
YES
NO
NA
LANDLORDS NAME
LANDLORDS PHONE
*DO YOU PLAN TO MOVE IN THE NEAR FUTURE?
Choose a DO YOU PLAN TO MOVE IN THE NEAR FUTURE?
YES
NO
*REASON FOR ADOPTION
*NUMBER OF ADULTS IN HOUSEHOLD?
NAMES/RELATIONSHIP OF OTHER ADULTS LIVING IN HOUSEHOLD
*NUMBER OF CHILDREN IN HOUSEHOLD
AGES OF CHILDREN
*DO YOU HAVE PETS NOW?
Choose a DO YOU HAVE PETS NOW?
YES
NO
HOW MANY PETS DO YOU HAVE?
*HOW MANY CATS?
*HOW MANY DOGS?
BREED/SIZE AND AGE OF CURRENT DOGS
*HOW MANY SPAYED/NEUTERED?
TELL US ABOUT YOUR CURRENT DOGS-WHAT KIND OF PERSONALITY DO THEY HAVE? GOOD WITH OTHER DOGS?
*CURRENT ON SHOTS
Choose a CURRENT ON SHOTS
YES
NO
WHAT PETS HAVE YOU HAD IN THE PAST?
OTHER ANIMALS? PLEASE EXPLAIN.
WHAT HAPPENED TO YOUR LAST PET/EXPLAIN
*HAVE YOU EVER LOST A PET TO:
'36' '99'
Choose a HAVE YOU EVER LOST A PET TO
POISONING
HIT BY CAR
DISEASE
STRAYED
STOLEN
OLD AGE
NA
EXPLAIN LOSS OF PET FROM ABOVE IF APPLICABLE
*HAVE YOU EVER HAD TO GIVE UP PET?
Choose a HAVE YOU EVER HAD TO GIVE UP PET?
YES
NO
NA
IF PET GIVEN UP/WHY?
*WILL YOU KEEP YOUR PET IF YOU MOVE?
Choose a WILL YOU KEEP YOUR PET IF YOU MOVE?
YES
NO
*ARE YOU PREPARED FOR THE COST OF NEW PET
Choose a ARE YOU PREPARED FOR THE COST OF NEW PET
YES
NO
*IS ANYONE ALLERGIC TO DOGS IN YOUR HOME?
Choose a IS ANYONE ALLERGIC TO DOGS IN YOUR HOME?
YES
NO
*WHO IS YOUR PRESENT VET?
*PRESENT VETS PHONE NUMBER
*WHERE WILL DOG LIVE?
Choose a WHERE WILL DOG LIVE?
INSIDE
OUTSIDE
*IF INSIDE DO YOU PLAN TO KENNEL IT?
Choose a IF INSIDE DO YOU PLAN TO KENNEL IT?
YES
NO
IF OUTSIDE HOW WILL IT BE CONFINED?
WHAT KIND OF SHELTER DO YOU HAVE?
*DO YOU HAVE A FENCED YARD?
Choose a DO YOU HAVE A FENCED YARD?
YES
NO
IF YES TO FENCE, WHAT TYPE OF FENCING AND HOW HIGH?
PLEASE NOTE: P.E.T.S. STRONGLY OPPOSES TETHERING DOGS FOR LONG PERIODS OF TIME. TETHERING DOGS FOR LONG PERIODS IS CRUEL AND CAN OFTEN TIMES LEAD TO AGGRESSIVE BEHAVIOR. WILL YOU AGREE NOT TO TETHER PET FOR MORE THAN 2 HOURS AT A TIME AND TO NEVER TETHER PET WITH A CHAIN? PLEASE MARK YOUR ANSWERS BELOW.
*NOT TO TETHER MORE THAN 2 HOURS?
Choose a NOT TO TETHER MORE THAN 2 HOURS?
YES
NO
*NEVER TETHER WITH CHAIN?
Choose a NEVER TETHER WITH CHAIN?
YES
NO
*HOW DO YOU PLAN TO EXERCISE DOG/EXPLAIN?
*HOW DO YOU PLAN TO HOUSE TRAIN DOG?/EXPLAIN.
DO YOU FEEL WILLING AND ABLE TO WORK WITH YOUR DOG AND CORRECT PROBLEM BEHAVIOR IF IT SHOULD DEVELOP, SUCH AS BARKING, CHEWING, JUMPING AND DIGGING? PLEASE ANSWER BELOW.
*HOW WOULD YOU TREAT BAD BEHAVIOR? EXPLAIN
*WHO WILL BE RESPONSIBLE FOR NEW DOG?
*HOW MANY HOURS A DAY WILL DOG BE ALONE?
*WHERE WILL DO BE KEPT WHEN LEFT ALONE?
YOUR DOG WILL BE MICROCHIPPED FOR PERMANENT IDENTIFICATION. DO YOU AGREE TO REGISTER THIS MICROCHIP WITHIN 10 DAYS OF ADOPTION AND HAVE I.D TAGS MADE FOR YOUR DOGS COLLAR WITH YOUR CONTACT INFORMATION ON THEM? PLEASE ANSWER BELOW.
*AGREE TO CHIP AND TAGS?
Choose a AGREE TO CHIP AND TAGS?
YES
NO
BOTH P.E.T.S ADOPTION POLICY AND IOWA LAW REQUIRE THAT ANIMALS ADOPTED FROM POUNDS AND SHELTERS BE ALTERED (SPAYED/NEUTERED).
*DO YOU AGREE WITH THE ABOVE STATEMENT?
Choose a DO YOU AGREE WITH THE ABOVE STATEMENT?
YES
NO
ARE YOU PREPARED TO GIVE YOUR DOG PLENTY OF TIME TO ADJUST TO ITS NEW HOME? WE ENCOURAGE THE 2 DAY, 2 WEEK TIME FRAME. IT WILL TAKE YOUR DOG APPROXIMATELY 2 DAYS TO BECOME FAMILIAR WITH THE NEW HOME AND 2 WEEKS TO BECOME COMFORTABLE WITH THE FAMILY AND OTHER PETS.
*WILL YOU GIVE THE DOG THE TIME NEEDED?
Choose a WILL YOU GIVE THE DOG THE TIME NEEDED?
YES
NO
I CERTIFY THAT THE INFORMATION I HAVE GIVEN IS TRUE AND AUTHORIZE INVESTIGATION OF ALL STATEMENTS MADE ABOVE
THANKS FOR YOU INTEREST IN ONE OF OUR RESCUED DOG-WE GREATLY APPRECIATE IT!! PLEASE NOTE THAT ALL OF OUR DOGS ARE KEPT IN HOMES WITH FOSTER FAMILIES AND IT MAY TAKE SEVERAL DAYS TO APPROVE YOUR APPLICATION AND MAKE ARRANGEMENTS WITH THE FOSTER FAMILY FOR A MEET & GREET. WE DO TRY OUR BEST TO GET BACK WITH YOU WITHIN 48 HOURS BUT SINCE WE ARE 100% VOLUNTEER SOMETIMES THINGS CAN BE HETIC. IF ONE OF OUR VOLUNTEERS HAS NOT CONTACTED YOU IN A FULL 48 HOURS PLEASE SEND US AN EMAIL AT PANORA_PETS@YAHOO.COM OR YOU MAY SEND US A PM VIA OUR FACEBOOK PAGE.THANKS!!!
I UNDERSTAND THAT P.E.T.S HAS THE RIGHT TO REFUSE ANY REQUEST FOR ADOPTION.
*PLEASE SIGN FULL NAME HERE
*DATE
PLEASE NOTE: ONCE YOU SUBMIT THE FORM YOU SHOULD RECEIVE A CONFIRMATION PAGE. IF YOU DID NOT RECEIVE THE CONFIRMATION PAGE YOUR APPLICATION DID NOT GET RECEIVED. IF ANY INFORMATION IS MISSING YOUR APPLICATION WILL NOT GO THROUGH. IF A QUESTION DOES NOT APPLY TO YOU PLEASE ANSWER NA. THANKS SO MUCH.
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