Dedicated to the coordination of orphaned animals and adoptive homes to ensure the survival of unwanted pets.
( 514 ) 217 - DOGS (3647)
Registered Charity # 89830-1007-RR0001

   

Adoption Questionnaire

Thank you for your patience and time completing this questionnaire.

The purpose of this questionnaire is to select the most compatible home for all of Rosie's dogs.

We will process your questionnaire as soon as possible. Occasionally we experience delays in returning correspondence and processing applications/questionnaires.

We appreciate your patience as we have no paid staff and our volunteers work hard trying to keep delays to a minimum.

Thank you!
 

Adoption Questionairre Adoption Questionnaire  

  Please fill in all fields marked with a *
 
  Title:
 * Name:
 * Address:
 * City and Province:
 * Postal Code:
 * Telephone (day):
  Telephone (evening):
  Telephone (work):
 * May we contact you by email? Yes      No
  Your email address:
 * How did you hear about Rosie's Animal Adoption? (200 characters max)
 * What type of dwelling do you live in?
 * Do You:    Own    Rent
 

If you rent, do you have your landlord's permission to have a dog or puppy?

 Yes     No
 * Have you ever had a pup/dog before? Yes     No
 

If yes, was pup/dog spayed/neutered?

 Yes     No
 

If yes, how long did you have it?
 

If yes, what happened to it?
 * Do you have any pets? Yes      No
 

If yes, please list:
 

If yes, will the other pet accept this dog/pup?

 Yes      No
 * Are you prepared to have this dog/pup spayed or neutered within 30 days, if not done so already? Yes      No
 * Number of children in your household:   (number)
 

If applicable, please list children's age and sex:
 * Has your family been exposed to dogs? Yes      No
 * Will the dog have contact with your children? Yes      No
 * Does anyone in your household have allergies? Yes      No
 * Is anyone in your household afraid of dogs? Yes      No
 * Where will the dog or puppy live?
 * Do you have a yard? Yes      No
 

If yes,  is it fenced?

 Yes      No
 

If yes, how large is it?
 * How many hours daily would the dog be left alone?   (hours)
 * Where will the dog be if you are away?
 * What vet hospital do you/will you use?  (name and phone number)
 * Under what circumstances would you give up your dog? (Please be specific - 400 characters max)
 * Have you had dog training before? Yes      No
 * Will you now? Yes      No
 * If the dog or puppy shows some behavior problems such as digging, chewing, jumping, playing, nipping, and eliminating in the house, what would you do to stop this? (200 characters max)
 * Are you aware of the cost to maintain a dog? Yes      No
 * Do you feel you have the financial ability to do so? Yes      No
 * If the dog is high energy, can you handle this? Yes      No
 * What do you know about this breed of dog? (200 characters max)
 * What can you offer this dog? (200 characters max)
 * We contact periodically the adopter for an update to help ensure that the dog successfully adjusts to it's new life. Do you consent to home visits after adoption? Yes      No
 * Are you aware that the rescued animals require an adoption fee and an adoption agreement? Yes        No
  Please add any additional comments here: (400 characters max)
  Dog's Name:
 * Name of person completing this application:
 * Date of this application:

              

Copyright 2005 Rosie Animal Adoption