AdoptionQuestionnairGailNew.doc
DALMATIAN RESCUE OF SOUTHERN CALIFORNIA INC.
ADOPTION QUESTIONNAIRE
We appreciate your interest in our dogs. To enable us to get to know you better, please complete the following questions. Please be as thorough and explanatory as possible.
Date: ___________________________
Name (include spouse or partner): ___________________________________________ Address (street, city, state and zip code): ______________________________________
_______________________________________________________________________
Home phone ____________Work phone _____________Cell Phone________________
Email address or addresses: _________________________________________________
Best time to be contacted and preferred method of contact (phone, email, text, mail):__________________________________________________________________
How did you hear about us? ________________________________________________
Are you a prior adopter and if so, who did you adopt from us and approximately when was that?_______________________________________________________________
Why do you want to adopt a dalmatian or a dalmatian mix?
Do all parties ( if there is more then one adult in household ) want a Dalmatian or dalmatian mix? ____________________________________________________
Have you ever owned a dalmatian or a dalmatian mix? Yes ___ No ____. If not, please describe what experience you have, if any, with dalmatians and dalmatian mixes:
Have you ever adopted a dog from a dog rescue group or an animal shelter?___________
Are you inquiring about a specific dog or dogs on our website, and if so, which dog or dogs are you interested in?
Please specify what traits or characteristics you are looking for in an adopted dog:
_____________________________________
Please indicate your level of experience (beginning, moderate or advanced) as a dog owner, indicating the basis of your experience: __________________________________ ________________________________________________________________________
Activities that you participate in that will include your dog:
Hiking __ Walking ___ Jogging ___ Agility ___ Camping ___ Dog Parks ___ Biking ___ Swimming/Boating ___ Other ___
Dalmatians and dalmatian mixes are generally high energy dogs. Please advise as to your plans regarding exercise for the adopted dog on a daily and weekly basis. ________________________________________________________________________
________________________________________________________________________
What dogs do you currently have (breed, age, sex ):______________________________ ________________________________________________________________________
________________________________________________________________________
What dogs have you owned over your lifetime? _________________________________ ________________________________________________________________________
What happened to your prior dogs?___________________________________________ _______________________________________________________________________
Have you ever given up a dog you owned to a friend, shelter or rescue, or returned a dog you adopted or purchased to a shelter, rescue or the adoptive party, and if so, please describe the circumstances. ________________________________________________________________________
How do your current dogs get along with other dogs? ____________________________
Are your current dogs spayed or neutered , and if not, why not: _____________________ ________________________________________________________________________
Have you ever trained prior dogs in obedience? ______ Are you willing to train in obedience? ___________
Are you willing to seek expert advice from a trainer or behaviorist should issues arise with the newly adopted dog?____________________________________________
What type of dog food do you feed your current dogs?________ Served watered or dry?_____ How much and how often? ____________________________
What type of dog food do you plan on feeding the adopted dog?_____ To be served watered or dry?_______________ How much and how often?________________
Do you feed your current dog table scraps or other people food, and if so, what types of scraps and how much_____________________________________________________
Do you plan on feeding the adopted dog table scraps or other people food, and if so what
types of scraps and how much ______________________________________________
Do you own cats or other small animals (rabbits, gerbils, hamsters, chinchillas, etc.)____ What type?___________ Are they kept separate from the dogs? ____________________
Do you own horses or other livestock?____ What type? ___________________________ Are they kept separate from the dogs? _________________________________________
Name, address and phone number of your veterinarian ________________________________________________________________________________________________________________________________________________
Do you have a fenced yard? Front ____ Back____ Side____ Not fenced ____________
Size of yard _______________ Fence height ______ Fence type ___________________
Will the adopted dog have access to all or only part of the yard?____________________
Please describe the yard including size and ground cover to which the dog will have access: _________________________________________________________________
What type of shade or cover is there in the part of the yard to which the dog will have access?_______________________________________________________________
What kind of accommodations do you have for the dog in the cold and in the heat? ____________________________________________________________________
Do you have a dog door, and if so, where does it lead?_________________________
Anyone home during the day? ____Explain __________________________________
Maximum hours dog would be left alone_____________ Explain_________________ ______________________________________________________________________
Where would the dog stay when you are not at home? ___________________________
Will the dog be allowed to live inside?_____________________________________
Where will the dog sleep? ______________________________________________
Do you own / have a dog crate? __________________
Do you plan on crating the dog, and if so, for what period of time?_____________
Do you maintain rat poison, snail bait or other poisons or toxins in your home, and if so, where are they kept and would the dog have any access to this area?________________
________________________________________________________________________
What do you do with your pets when you go on vacation? ___________________
__________________________________________________________________
Ages of children in contact with dog ____________________________________
Do the children have prior experience with dogs and if so, describe experience _______
_______________________________________________________________________
Any asthma or allergies in household to dogs or cats?_____________________
How severe ? ______________________________________________________
Describe neighbors that the dog will be involved with (do they like dogs? have children? have dogs, cats?) ___________________________________________________
Any problems currently with neighbors? _____________________
Explain _____________________________________________________________
Do you own your home? __________________
If not, do you have permission from landlord to own dogs there? ______________
Any questions about the breed or dog ownership that we may answer for you? ______________________________________________________________________
Adopted dogs need an adjustment time, are you willing to give the new dog at least a month adjustment period after the adoption? __________________________________
What in your opinion would constitute a reason for not keeping the dog? ______________________________________________________________________
______________________________________________________________________
We are always in need of temporary homes for our rescue dogs, would you be willing to foster a needy Dalmatian if it is compatible with your lifestyle and pets? __________
For how long ____________ until placed? __________
We will be requesting an adoption fee to cover our costs including shelter fees, veterinarian fees, foster care expenses and kennel costs.
By signing this questionnaire you acknowledge that completion of this form does not guarantee that we will place a dog with you. You must first pass our interview, our home inspection and complete one of our Adoption Contracts including at least 2 post adoption home visits for the purpose of checking on the dogs well being. We reserve the right to terminate the adoption process at any time.
Sign here __________________date ____________________
Please return by email to dalrescue@
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