PDF Phone Interview for ADOPTERS Form

PHONE INTERVIEW FOR ADOPTERS FORM

Date of Interview:

Your name:

Your email: Applicant name:

Which one did you speak with? Were they both on the line?

Applicant City, State:

WHICH STATE should receive this report? (This is the same team that assigned you the interview.) check one

NC/SC Adoption Application Screening GA/LA/MS Adoption Application Screening FL/AL Adoption Application Screening TN/KY Adoption Application Screening AR Adoption Application Screening MI Adoption Application Screening MN/IA/DS/ND Adoption Application Screening NM Adoption Application Screening TX Adoption Application Screening

FAMILY

Please tell me the names and ages of all family members currently living at home.

Are there any children that VISIT regularly in your home?

Yes No

If "Yes" what are their ages and have they been around pets before?

Have ALL of the adults in the home agreed to adopt a Springer? Yes No Who would be the primary caregiver for an adopted Springer?

What is the work status and occupations of the adult(s) in the home (full-time, part-time, stay-athome, retired, one or both)?

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(NEXT QUESTION ADDRESSES HOURS/DOG'S TIME ALONE.) How many hours would the dog be home alone on a typical day? How often? Have them elaborate on work hours, or if they are retired or stay-at-home, ask about how often they go out for errands or activities or appointments.

Where will the Springer stay when you are not at home? Full access, restricted access? How? Where?

How often are you away for vacation or out of town? What are your plans for the Springer?

HOME ENVIRONMENT AND YARD

Describe your home and neighborhood.

Do you live in a subdivision? apartment? Condo? Cul-de-sac? Single family home? Are you in the city, suburbs, or country?

Is your home close to a main street or highway with busy traffic?

Yes No

Is there part of the yard fenced in for exercise and potty breaks? (please check) Yes, fully fenced. Partially Fenced. No fencing. Invisible/underground fencing. No yard.

Describe the fenced or invisible-fenced area.

What size is the area?

Is any of the fence adjacent to the house?

If physically fenced, what is the height and material of fence?

Is there a kennel or run or pen?

No Yes

Describe kennel, run, or pen and when it is/was used.

If not fully fenced what are your plans for potty breaks?

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Looking for intent to keep dog leashed, or whether they expect to train him/her to stay in yard. Concern to discuss if they plan to train dog to stay - remind them that many Springers have a strong prey drive for birds and squirrels or deer, and could run off. Some dogs may never be trustworthy off-leash.

If invisible/underground fencing, how do you train the dog to the boundaries?

If not fully fenced or invisible fenced, are there ever any dogs roaming free in the neighborhood?

Yes

No Rarely

Under what circumstances might your dog(s) be in the yard without supervision, such as access by dog door or left outside when you are gone?

PETS IN THE FAMILY Do you currently have a Springer or had one in the past? Yes No IF yes, Tell me about your Springers.

IF no, Have you ever met or been around any Springers? What were your impressions? If not mentioned above, what other pets do you currrently own? (type, breed, gender, age, etc)

What other past pets did you own?

(If not already discussed above, list type, breed, gender, age, and YEAR that he/she passed away.)

Are your current pets spayed/neutered? (please check one)

Yes

No N/A

Not a current pet owner

If not, was there a reason?

Were PRIOR pets spayed/neutered? (please check one)

Yes

No N/A Not a prior pet owner

If not, was there a reason?

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Have you maintained your current and your past pets on Heartworm prevention ALL YEAR ROUND? Yes No N/A Not a prior pet owner Do you or did you use flea/tick preventative all year round? (please check one) Some people do not need flea/tick prevention in cold months. Yes Not all year-round. Not applicable. Not a prior pet owner. Have never used this.

Any comment on HW meds or flea/tick preventative.

Have you ever had to give up a dog in the past (such as sent to a shelter or found another home for him/her)? No Yes N/A Not a prior pet owner If Yes, please describe the circumstances:

Can you think of any circumstances in which you would have to give up your pet(s)? (i.e. moving or illness.) If applicants are of child-bearing ages, see next question.

****NEW QUESTION April 19**** Do you have plans if you are unable to care for your dog(s) due to illness or death? (Note: ESRA will always take one of our dogs back.)

IF APPLICABLE: One of the most common reasons that people relinquish a Springer to rescue is due to the presence of young children. Life becomes too busy to meet the exercise and attention needs of the Springer. Do you foresee any issue with that in the future? Yes No Not applicable If they have just 1 dog at present and are looking for a second dog: Have you ever had more than 1 dog at a time? Yes No Already a multi-dog household N/A No current pet or not a prior pet owner IF YES, tell me how you managed the pack. Did you have any issues, such as over food or toys?

CARE AND MANAGEMENT OF AN ADOPTED SPRINGER

When you are home do your pets have or will have free roam or will certain areas be restricted (i.e. bedrooms / bathrooms, formal rooms, couches/chairs) ?

How do you plan on restricting movement to/on these areas ?

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Where do/will your pets sleep (i.e. crate, bed, near the family, in a separate area)?

Are you familiar with use of crate-training? Yes No Yes, but doesn't like it

Some of our Springers are crate-trained and feel more secure sleeping or eating in their crate or staying there when home alone. Would you consider purchasing or using a crate if necessary ? Yes Does not wish to use a crate Maybe

If not using a crate, how will they restrict access when the dog first comes to live with them?

Some dogs will need a housetraining referesher in a new home and some dogs feel overwhelmed if they have full access right away, or you might need a slow introduction to other pets / children in the home.

Any crating comments.

ACTIVITY LEVEL OF FAMILY AND EXERCISE OF THE DOG

How active is your lifestyle? What kind of activities do you and your family enjoy that might include the dog?

Are you aware of the high energy level of most Springers?

Yes No

What daily exercise do you plan to offer a Springer?

How often on a daily basis? What is their idea of "a walk?"

In the interviewer's opinion, does their plan sound reasonable for exercise? Or do we need to discuss it more at home visit and matching?

DOG HANDLING SKILLS Have you ever participated in any Dog Obedience Training in the past?

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