CANINE ADOPTION QUESTIONNAIRE
Date:
Your Name: Spouse/Partner Name:
Address:City:Zip: How long at this address?
Home phone:Cell Phone:
Email: Alternate email:
Name of puppy/dog(s) you are interested in adopting:
How long have you thought about adopting a canine?
How did you hear about The Milo Foundation?
Within which age group do you fall: Under 21 21-29 30-44 45-60 61-70 71-79 over 79
Number of other household members (and ages of anyone under 21):
Does everyone in your household know you are applying for a dog?
Please check all that best describe your living situation:
Own Rent Military Live with Parents Live with Roommates
If you rent, landlord name and telephone:
May we call your landlord? Yes No Can you provide a copy of your rental agreement? Yes No
Are there any rules or restrictions regarding pets in your residence?
Do you have a yard? Yes No Is it securely fenced? YesNoTypeHeight
Dog door? Yes No
Who will be the primary caretaker of this dog (Responsible for feeding, training, playing with, walking, etc.)?
To facilitate a successful match, please tell us a little about yourself
Which best describes you? Have never had a dog beforeGrew up with dogs This will be first dog as an adult Have had one or two dogs before as an adult Have had many dogs as an adult
My pet parenting style is: a pushover fair and firm top dog
I most like a dog who is a: couch potato weekend athlete total jock
I prefer my dog to be: a wallflower my biggest fan a party animal
While at home, I like my dog to: be velcro make the rounds be a free spirit
My dog needs to be able to be alone: 9+ hrs/day7-9 hrs/day 4-7 hrs/dayless than 4 hrs/day
I need my dog to get along with:dogs catschildren family everyone other
My favorite thing to do with my dog is:
It's most important to me that my dog:
The location I prefer my dog to sleep is:
How long can you allow for your new dog to adjust to your home?
What will you do to provide mental stimulation and exercise for your dog?
If you were no longer able to care for your dog, what options do you have?
The Milo Foundation, PO Box 6625, Albany, CA 94706 - (510) 900-2275 -
Current Pets
Name Name Name
Species Breed(s) Species Breed(s) Species Breed(s)
Gender Age Gender Age Gender Age
Spayed/Neutered Yes No Spayed/Neutered Yes NoSpayed/Neutered Yes No
Kept Indoors OutdoorsBoth Kept Indoors OutdoorsBoth Kept Indoors OutdoorsBoth
How long have you had this pet?How long have you had this pet? How long have you had this pet?
Past Pets
Name Name Name
Species Breed(s) Species Breed(s) Species Breed(s)
Gender Age Gender Age Gender Age
Spayed/Neutered Yes No Spayed/Neutered Yes NoSpayed/Neutered Yes No
Kept Indoors OutdoorsBoth Kept Indoors OutdoorsBoth Kept Indoors OutdoorsBoth
Years pet was with you? to Years pet was with you? to Years pet was with you? to
Reason no longer with you?Reason no longer with you? Reason no longer with you?
Name of current or most recent Veterinarian(s), Veterinary Hospital, and City (Telephone Number, if available):
Do you mind if we call your veterinarian? Yes No
Have you ever had to give up an animal before?Yes No What happened?
Have you ever euthanized an animal before (NOT because of age/health)? Yes No
If yes, what was the reason?
Have you ever had a dog with a behavioral problem? Yes No If yes, what did you do?
Why are you looking for a companion animal? (Please check all that apply)
Security Company for other pet Company for meOther
As a gift For child Company for other household member
My dog will live: mostly indoor about half and half mostly outdoors only outdoors
Do you plan on attending training classes with your new puppy/dog?YesNoMaybe
What training methods will you use?
What, if any, training books have you read and liked?
What will you do if your dog is not housebroken?
Do you have children? YesNo
If no, do you plan on children in the future? Yes No
If so, how will you introduce your dog?
Are there allergy concerns in your household? YesNo
How much have you budgeted for the yearly care of your dog? $
What brand(s)/types of food will you feed your new dog?
Is there anything else you think is important in evaluating your application?
The Milo Foundation, PO Box 6625, Albany, CA 94706 - (510) 900-2275 -