Dog Adoption Questionaire - Kittery Animal Hospital

Download & Print Form

Date*

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Email*

How did you hear of us?*

Please specify the animal(s) you are interested in adopting:*

Do you currently live in a:*

House
Apartment
Condo

Do you currently*

Rent
Own

If you rent, may we contact your landlord to verify their pet policy?*

Yes
No

Landlord’s Name*

First Last

Phone*

How many adults live in your home?*

How many children?*

Ages*

Does anyone in your household have pet allergies?*

Yes
No

Who will be primarily responsible for the care of this dog?*

Is this dog a gift?*

Yes
No

For whom?*

How many hours will the dog be alone each day?*

Where will the dog be kept at night?*

Do you have a fenced yard?*

Yes
No

Please list all of the pets you currently own

Name*

Breed*

Age*

Spayed/Neutered?*

Yes
No

Please list any behavioral problems:*

Add another pet?*

Yes
No

Pet #2

Name*

Breed*

Age*

Spayed/Neutered?*

Yes
No

Please list any behavioral problems:*

Add a third pet?*

Yes
No

Pet #3

Name*

Breed*

Age*

Spayed/Neutered?*

Yes
No

Please list any behavioral problems:*

Add a fourth pet?*

Yes
No

Pet #4

Name*

Breed*

Age*

Spayed/Neutered?*

Yes
No

Please list any behavioral problems:*

Add a fifth pet?*

Yes
No

Pet #5

Name*

Breed*

Age*

Spayed/Neutered?*

Yes
No

Please list any behavioral problems:*

If you have other pets, are their vaccinations current?*

Yes
No

If you have other pets, are they currently licensed by your town?*

Yes
No

Do you have a regular veterinarian?*

Yes
No

Vet’s Name*

Phone*

Would your budget allow for emergency care should it become necessary?*

Yes
No

*

In the event that the original owner comes forward I agree to return the pet to the original home.

Date*

I certify that the above information is true and correct to the best of my knowledge. I also acknowledge falsification of the above can result in my being denied adoption of an animal or, if an animal has been adopted to me, the return of that animal to Kittery Animal Hospital. I understand that all animals adopted from Kittery Animal Hospital must successfully pass a health and temperament screening before they are released from the shelter. Kittery Animal Hospital reserves the right to disapprove any application that does not meet our review process.*