Adoption Questionnaire
Date
Applicant's Name
Address
City & Province
Postal Code
Daytime Phone Number
Evening Phone Number
At what hours can you be reached at the above numbers?
May we contact you by Email?	yes no
Email Address
Where did you find out about Teddy's?	Internet Search Other Petfinder Previous Adopter
Occupation
Age
Are there other members of your household? If so, briefly give their names, sex and ages.
Do they agree with your decision to get a dog?	yes no
If you have children, will they be responsible for the care of your dog?	yes no
If not, are you planning to have children in the future?	yes no
Are there a lot of children in your neighbourhood?	yes no
Are you frequently visited by children?	yes no
If yes, do any of them have access to your yard/house when you are not home?	yes no
Is anyone in your household allergic to dogs?	yes no
Is anyone in your household elderly or frail?	yes no
Is anyone in your household afraid of dogs?	yes no
Do you have close neighours who might be affected adversely by a barking dog?	yes no
Why have you decided at this point to get a dog?
Why have you decided on adoption?
Have you ever had a dog before? If yes, what happened to the dog?
Have you ever adopted a dog before?	yes no
Is there a specific dog you are interested in on our site?
Briefly explain why you are interested in this dog and what you know about it's breed.
Do you have other pets in the home? If yes, briefly explain each pet and it's veterinary care.
Have you ever surrendered or given away an animal? If yes, please explain circumstances.
Have you ever been bitten or attacked by a dog?	yes no
Are you comfortable approaching dogs you do not know? Please explain.
If behaviour problems arose in your dog, how would you deal with them?
Are you familiar with animal regulations in your area?	yes no
Do you know the requirements for obtaining a dog license in your town?	yes no
Please list three references who are knowledgeable about your care of dogs. Please include your vet.
Do you have a preference for a dog? Age? Sex? Breed?
Would you consider a dog that has physical or emotional problems?	yes no
If breed specific, are there any traits in the breed that you would prefer to avoid? If yes, explain
What specifically are your expectations for this dog?
Is your neighbourhood rural or suburban?
What type of dwelling do you live in?	Apartment Condo Farm Semi-detached Single Family Home Townhouse
Do you rent or own?	Own Rent
If you rent, do you have permission from your landlord to have a dog?	yes no
Would your landlord be willing to put the permission in writing?	yes no
Are there any restrictions as to the number of dogs/cats that you may have in your residence?	yes no
How large is your property?
Do you have livestock or other animals? If so, how many and what types?
Do you have a fenced yard? If so, please describe.
Are you opposed to a home visit?	yes no
Are you willing to travel a distance to meet the dog? If so, how far?
Is there someone home during the day? If not, how many hours will the dog be alone most days?
Will the dog live in the house with the family? If not, where will it be kept during the day? Eve?
When you go away during the day, where will the dog be left?
If you go away for an extended period (overnight or longer) where will the dog stay?
Will the dog be allowed to run loose at any time?	yes no
Will you have your dog on a run, trolley or tied outside at any time?	yes no
Do you plan on taking some obedience courses? If not, how to you intend to train the dog?
If you intend to train the dog yourself, please give a detailed description of your experience.
What do you expect your annual veterinary fees to be?
How do you intend to exercise the dog?
Please add any information about yourself that you think would be useful in helping us select a dog.
I attest to the truthfulness of my answers and that TCR has the right to refuse any adoption. Sign:
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