God s Grace Canine Rescue, Inc. Adoption Questionnaire. Your Name: Address: Home Phone: Cell Phone: Employer: Work Phone:

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1 Your Name: Address: City: State: Zip: Home Phone: Cell Phone: Employer: Work Phone: Address: City: State: Personal References Please list 2 references other than a family/household member who are familiar with your experience as a pet owner. 1. Name: Phone: Address: Relationship: 2. Name: Phone: Address: Relationship: Veterinarian Reference Name: Phone: Address: How long have you used this veterinarian? Do we have your permission to contact your personal and veterinary references? Yes No Have you or any other household member ever been charged with or convicted of animal cruelty/neglect or domestic violence? Please Explain if yes. 1

2 Household Information Do you: Rent Own What type of home? single family house Apartment/Condo Other If other, please explain. Are there any covenants or restrictions concerning dogs where you live? Please specify. If you live in an apartment or rent a home, does your lease allow you to have a dog? Landlord s Name: Phone: Address: Do you have a fenced in yard? If so, please describe the fence (height, type of material, how gates are locked). If you do not have a fence, how will you manage your dog s potty training and exercise needs? Do you agree to keep your dog ON A LEASH AT ALL TIMES in any unfenced areas? Do you have or do you intent to install a dog door? Do you subscribe to a chemical lawn service or use chemical/pesticides on your lawn? If so, are you aware of the dangers that chemicals/pesticides may pose to your pet and agree to keep your pet off of these treated areas?? If you are a smoker, do you smoke indoors? Yes No 2

3 Please list all individuals residing in your home, including children, their ages and the hours they are usually home. (If more space is needed, please attach a separate sheet to this document). Name Age Hours Home Are all members of your family in agreeance about adopting a dog? Who will be primarily responsible for the pet s care and training? Please explain. Are you expecting a child or planning a family in the future? If so, will this affect your responsibilities or ability to own a pet? How often do you travel? Who will care for your pet while you are away? Is anyone in the household allergic to animals? If so, please specify how this will impact your ability to provide a good home for the pet. How would you describe your household activity level? Very Quiet Easy-going Usually something going on Lots of Activity 3

4 Other Pets Please list all other pets residing in the home, including type of pet, age, gender and if applicable, spayed or neutered. How many dogs have you owned in the past 5 years? Please provide the breed, age, gender, if spayed or neutered, and if deceased, cause of death. Have you ever bred any of your pets? Have you ever given an animal away to anyone or surrendered one to a shelter or rescue? If so, please explain. (this does not necessarily disqualify you for adoption) Experience/Expectations Why did you choose this breed you are looking to adopt? Are you familiar with any health and safety issues related to this breed? Please describe. Are you familiar with any of the habits/behaviors typical to this breed? Please Explain. Are you aware that there is an adjustment period for any animal being brought into a new environment? 4

5 Where will your dog spend the day? (check all that apply) Loose indoors Crate Basement Garage Fenced Yard Dog Run Chained Outside kennel run Loose outdoors Other Please Explain: Where will your dog sleep at night? How many hours per day will the dog be alone? Will you allow your dog on furniture? How much do you anticipate you will spend annually on the care of your pet, including food, supplies, training, and veterinary care? What type of food will you feed your new pet? Are you aware of the nutritional differences in dog food brands? Under what circumstances would you return the dog to the rescue? Under what circumstances would you ever choose to humanely euthanize your pet? Are you willing to invest time/resources into a trainer to work with the dog should he/she require training for behavioral issues that may arise now or in the future? 5

6 Would you accept a dog with special needs or medications? Are you willing to undergo a home visit in order to be considered for adoption from God s Grace? Is there any other information you wish to furnish with regards to this application? I hereby affirm that the information provided in this questionnaire is true and accurate to the best of my knowledge and understand that God s Grace Canine Rescue, Inc. reserves the right to approve or deny any application for any reason. Your signature Printed Name Date **Visual breed identification in dogs is unreliable so for most of the dogs we are only guessing at predominant breed or breed mix and age. We get to know each dog as an individual and will do our best to describe each of our dogs based on personality, not by breed label.** **DNA testing on an adoptable dog is available at the request and expense of the adopter. Please if you would like to request DNA testing on the dog you are interested in adopting to determine exact breed(s). There is a $50 fee for this service payable at time of request.** 6

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