Animal Friends: Survey - Adoption Application: Dog

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Adoption Application: Dog

*1.

Question - Required - What type of dog are you looking for?

Please provide your contact information.

If you have previously registered, please login here to prepopulate your information.

Name:

Title	First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number: Required

Employer:

Occupation:

If you respond and have not already registered, you will receive periodic updates and communications from Animal Friends.

Remember me. What's this?

*3.

Question - Required - What county do you live in?

*4.

Question - Required - How long have you lived at this address?

*5.

Question - Required - How did you hear about Animal Friends?

*6.

Question - Required - Please indicate your age range. (Here's why we're asking: you must be 21 or older to adopt. Adopters over 60 are eligible for special benefits.)

*7.

Question - Required - How much money do you imagine spending on this pet throughout the year?

*8.

Question - Required - Do you:
Please make at least 1 selection from the choices below.

	Own your home
	Rent
	Rent to own
	Live with parents
	Live with a partner
	Live with roommates
	Live alone

Question - Not Required - If you live with others, do they want a dog? (Leave blank if you live alone.)

*10.

Question - Required - Do children under age 18 visit (or live in) your home?

11.

Question - Not Required - If other people live in your household, please list their ages. (Leave blank if you live alone.)

(Maximum response 255 chars, approx. 5 rows of text)

*12.

Question - Required - Would this be your first dog?

*13.

Question - Required - Will this dog live

*14.

Question - Required - Do you have past experience with introducing a new dog to the household?

*15.

Question - Required - How will your dog get exercise?
Please make at least 1 selection from the choices below.

	Walks
	Fenced yard
	Dog park
	Other

*16.

Question - Required - Why do you want this dog?

*17.

Question - Required - Would you ever give up this pet? If so, what might be the reasons?

(Maximum response 255 chars, approx. 5 rows of text)

*18.

Question - Required - Are you willing to provide behavior training?

*19.

Question - Required - MUST this dog be housebroken at the time of adoption?

*20.

Question - Required - If the dog is not housebroken, how will you housetrain?

(Maximum response 255 chars, approx. 5 rows of text)

*21.

Question - Required - Please indicate the animals that have lived with you in the past 5 years:

	Spayed or Neutered dog(s)
	Spayed or Neutered cat(s)
	Spayed or Neutered rabbit(s)
	Unaltered dog(s)
	Unaltered cat(s)
	Unaltered rabbit(s)
	Other animal(s)
	I have not lived with any pets in the past 5 years.

22.

Question - Not Required - Are any of these pets no longer with you? If so, let us know why they no longer live with you. (Leave blank if this will be your first pet.)

23.

Question - Not Required - Previously, have you taken your pets for regular veterinary care? (Leave blank if this will be your first pet.)

24.

Question - Not Required - Please provide the name, address, and phone number of your pet's veterinarian. (Leave blank if this will be your first pet.)

(Maximum response 255 chars, approx. 5 rows of text)

*25.

Question - Required - Which of the following live with you RIGHT NOW?

	Spayed or Neutered dog(s)
	Spayed or Neutered cat(s)
	Spayed or Neutered rabbit(s)
	Unaltered dog(s)
	Unaltered cat(s)
	Unaltered rabbit(s)
	Other animal(s)
	I don't have any pets right now.

*26.

Question - Required - I certify that the above information is true and correct. I understand that any intentional misrepresentation may result in application denial. I understand that Animal Friends reserves the right to refuse the placement of any animal. I understand that submission of an application does not guarantee an adoption.

*27.

Question - Required - How would you like us to contact you?

Pet Adoption & Resource Center | 562 Camp Horne Road, Pittsburgh, PA 15237 | 412.847.7000
Come visit us! Monday - Friday 11am - 7pm | Saturday & Sunday 10 am - 5pm

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