Stratford Animal Shelter

Stratford Animal Shelter

Dog Adoption Questionnaire

Thank you for considering the adoption of a pet from the Stratford Shelter. Your complete answers to the

following questions will help us to find a pet that best matches your requirements and your lifestyle.

NOTE: Our dog adoption fees range from $50-$100 dollars, depending on veterinary and impoundment fees. This includes a discount

coupon for spay or neuter surgery. Your dog may also require age-appropriate vaccines, heartworm testing and preventative,

de-worming medication and flea and tick treatment.

Date Submitted: Your Full Name:
Which dog, or which type of dog, are you interested in?
Your Street Address:
City, State, Zip:
Home Phone:
Work Phone:
How long have you lived at this address?:
Is your residence a House Apartment Condo Do you own or rent
Mobile Home Other:
If renting, does your lease allow pets? Landlord’s Name and Phone Number:
Yes No Not Sure

Do you have any other pets? If so, list them here:

Pet’s Name / Type – dog, cat, other / Current Age / Neutered? / Indoor, Outdoor or Both / Vet’s Name and Phone #

Have you owned any other dogs within the last 10 years? If so, describe the type of dog, when you owned it, when and

why you stopped owning it, and what veterinarian you used.

Do you have a fenced in yard? If you do not have a fence, how will you handle exercising and toilet duties?

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

Where will the dog be kept when left alone?

Where will the dog spend the time when you’re home?

Where will the dog sleep at night?

Do you have children? What are their ages?

How long do you expect it will take for your new dog to adjust to you, your family and its new environment?

What, in your opinion, would constitute reasons for “giving up” a dog?

Have you ever done so? If so, why?

To whom was it given?

Have you ever experienced behavior or training problems with your dogs?

Please give details:

Are you willing to use the services of a trainer if behavioral problems develop?

Are you familiar with crate training, used for housebreaking and training? Do you intend to use this method?

What veterinarian will you use for this pet?

Dogs require a lot of your time, love and attention. The costs of owning a dog include food, vaccinations, heartworm preventative and testing, licensing, boarding, training and veterinary care during emergencies. Please consider these requirements before adopting a dog. Be sure you are willing to commit to a new family member who will be with you for the next 10-20 years.

I hereby affirm that I have answered the above questions truthfully and to the best of my knowledge. I give my permission
for the Stratford Animal Shelter to contact the landlord, veterinary and personal references I have provided, and I give
my permission for these references to release any information they deem relevant to the adoption of an animal from the
Stratford Animal Shelter.

Signed:Date: