Kent County Animal Shelter - Dog Adoption Survey
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1
2Kent County Animal Shelter- Dog Adoption Survey
Spouse’s Name:
Name:
Date:
Address:
City:
State:
Zip:
Email:
Phone 1:
Phone 2:
Are you over 18 years of age? Yes No
Are you over 62 years of age? Yes No
General Information:
1.
Please list household members:
Name
Age
Relationship
2.
Do you run a day care or babysitting service in your household? Yes
No
3.
Do you OWN your home or RENT your home?____________________________________
If you rent, or live in a home owned by a relative, what is your landlord’s/relative’s name and phone number?
4.
_______________________________________________
5.
List all dogs, cats and ferrets CURRENTLY living at your home:
Name
Breed
Age
Sex (M/F)
Neutered?
Indoors or Out?
How long owned?
6.
List all dogs & cats who have lived with you in the past 5 years but who are NOT CURRENTLY with you:
Name
Breed
Age
Spay/Neutered?
Indoor or Out?
Where is the animal now?
11. What will your pet’s indoor areas
7.
How often do children or teens visit?
15. Prioritize 3 activities you would like to
o
Daily
include?
do with your pet (fetch, jogging, etc)
o
o
Numerous times/week
Full access to rooms
1)
o
o
1-4 times monthly
Limited access to rooms
2)
o
o
Infrequently
Allowed on furniture
3)
o
Allowed on some furniture
16. How often will you walk your pet off
8.
Would you say your current lifestyle
your property for mental stimulation?
is
12. Where will your pet sleep?
o
Twice daily
o
o
Very Hectic
Crate
o
Once daily
o
o
Moderately busy/ controllable
Their own bed
o
Family member’s bed
Once weekly
o
o
Calm/ Quiet
o
Less than once a week
o
Outside
9.
Are there any major family changes
o
Other
17. Who will be in charge of feeding?
in your near future?
o
Family members take turns
o
Birth of a child
13. Where will your pet be kept when you
o
Mom/Dad
o
Household move
are not home?
o
Individual
o
o
Schedule Change
Crate
o
o
Marital Change
Outside
18. Who will be in charge of cleaning up?
o
o
Other
Free access to house
o
Family members take turns
o
Specific room
o
Mom/Dad
10. Is anyone in your family allergic to
o
Individual
animals?
14. How much time do you plan on
o
No
interacting with your dog daily?
19. Approximately how long will your dog
o
Yes
(training, playing, grooming, exercise,
be left ALONE on a typical day?
o
If yes, please specify
etc)
1-4 hours
o
o
< 1 Hour
4--8 hours
o
o
1-2 Hours
8-10 hours
o
o
>3 Hours
More than 10 hours
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