General Questionnaire
Full Name:
Street, City, State, Zip Code
(physical address):
Home Phone#:
Name the dog are you interested in?
Or describe the type of pet you are looking for (e.g. young/adult, m./fem., sm./med./large, long-haired/short-h.)?
Do you currently own pets?  If so, what kind?
Do you have children/grandchildren? What age?
Do you own/rent?
Do you have a yard/
fence/height of fence?
Where would you keep the pet
during the day?
at nights?
What is your main reason for adopting a pet?
Is anyone in your family allergic to dogs/cats?
Have you had a pet before?  Please list all pets previously owned:
Dog or Cat?
For how long?
Reason for surrender
Are you aware, that adopting a pet is a lifetime commitment and should not be a spur-of-the-moment decision?
Are you aware that a lot of these dogs/cats up for adoption have been handed around (sometimes even abused)  
and are therefore looking for a loving, understanding and PERMANENT home?
The dog's optimum health must be maintained through the feeding of quality dog/cat food (recommended are: Innova, Evo, Nutro, Nature's Recipe, Canidae, Wellness) and adquate shelter.

The adopted pet MUST wear identification at ALL times. 

E-Mail Addresses (home & work):
List vet reference (name & phone number):
How long would the dog/cat be alone during the day?
How long have you lived at current address?
Occupation (list both if joint):
Name of Employer (list both if joint):
Cell Phone # (list both if joint):
Work Phone# (list both if joint):
Mailing Address (if different from above):
I hereby release K9 RESCUE REFERRAL from any liability, damage or injury hereafter caused by said animal.
I understand that some or all of the information provided regarding said animal may have been received by K9 RESCUE REFERRAL from a third party.
I understand that K9 RESCUE REFERRAL does not warrant the accuracy of any information given by other shelter/rescue or individual where the dog/cat currently resides..
email me
***This is just a questionnaire to provide general information about your home
and NOT a commitment to adopt.***
NoYes
NoYes
OwnRent - Name & ph.# of landl.
No yardYard-fence-How high? Dog door?
NoYes
YesNo
YesNo
I agree
I agree
I agree