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Pre-Adoption Questionnaire
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Adoptable Animals

Pre-Adoption Questionnaire

PLEASE READ. The adoption of an animal should not be impulsive, but rather a carefully thought out decision, which will ensure a loving, lasting relationship. Before you adopt an animal, remember that you are applying for a lifetime companion, for whom you will be responsible.

Name(s) of animal(s) who you are interested in adopting*
Your name*
Are you 18 years or over?*
- Yes
- No
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Work Phone
Email*
Are you willing to make the investment in both time and finances to properly care for and manage your new pet?*
- Yes
- No
Do you:*
- Own
- Rent your residence
If you rent, can you show proof that the landlord allows animals?
- Yes
- No
Do you live in a:*
- House
- Condo/Townhouse
- Apartment
Is there a fenced back yard?*
- Yes
- No
How many adults are in your household?*
How many children?*
Ages
- 1-5
- 6-9
- 10-13
- 14-18
Do ALL the members of your household want a new pet?*
- Yes
- No
If not, please explain:
Over the years, how many dogs and cats has your current family had?*
Have you relinquished or given away any pets before?*
- Yes
- No
Is so, where did you take it?
Please list current pets residing at your home (including roommates' pets also). Include pets' breed, age, sex, spay/neuter status, number of years owned, and if they live indoors or outdoors.
What would you do if your new pet urinated on your rug?*
What would you do with your pet if you suddenly had to move?*
What would you do if your pet got injured or sick and the estimate to treat him was over $1,000?*
What is your feeling about spaying/neutering your animal(s)?*
What time do the working people leave in the morning?*
What time do they arrive home?*
In a 24-hour day, how long would the pet be left alone at a given time?*
Where will your new pet be kept when you are home?*
Where will your new pet be kept when you are NOT at home?*
In a 24-hour day, how long would the animal be indoors?*
When outdoors, how your pet would be confined (examples might include zip line, fence, etc.)
When outdoors, what type of shelter would be provided?*
When outdoors what type of shade would be provided?*
Are you looking for (choose one)*
- an indoor pet
- an indoor/outdoor pet
- an outdoor pet
What personality traits are important to you?*
What appearance characteristics are important to you?*
I want this animal for (please choose all that apply)
- Myself
- Breeding
- My Child
- Family Pet
- Companion
- Watch Dog
Do you already have a veterinarian? If yes, Name:*
Do you plan to get pet insurance?*
- Yes
- No
Why or why not?*
What feeding schedule will you use?*
Will you feed dry or canned/ wet food?*
Where will your new animal sleep?*
What arrangements would you make for your new animal if you went on a trip/vacation?*
Hidden
If something was to happen to you who would be the God Parent to your new pet?*
If something was to happen to you who would be the God Parent to your new pet?
Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Relationship*

Location

ANIMAL REFUGEE RESPONSE

11767 Candy Lane
Lower Lake, CA 95457

Contact

(707) 330-3747
blythe@animalrefugee.org

Animal Refugee Response is a strictly NO-KILL 501c(3) non-profit organization dedicated to animals in need.
ID #45-3248828

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