adoption_survey_application_dog_or

Dog or Puppy Adopter Survey/Application

*If you have any questions or concerns, please contact info@petcentralhelps.org.

Which dog(s) or puppy(s) that you are personally interested in meeting that is listed on our website or social media? (1st choice) *

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Please list the name here (2nd choice):

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Please list the name here (3rd choice):

0/75 characters

Name *

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Phone Number: *

0/75 characters

Email Address: *

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Address Line 1: *

0/75 characters

Address Line 2:

0/75 characters

City: *

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State: *

Zip Code: *

I have owned a dog before? *

YES

NO

CURRENTLY OWN DOG(S)

The last time I had a dog was . . . *

2-10 Years ago

10+ Years

Not currently, but within the past year

My dog needs to get along with other dogs? *

NO

YES

Please list names, ages, genders and breeds of other pets. *

My dog needs to be good with:

My dog will primarily be an... *

Inside dog

Outside dog

My dog needs to be able to be alone (per day) ... *

How many hours will your dog spend outside per day? *

When I'm at home, I want my dog to be by my side... *

All of the time

Some of the time

Little of the time

When I'm not at home, my dog will spend her time... *

I want a guard dog? *

NO

YES

I want my dog to hunt or herd with me? *

NO

YES

I want my dog to be the type that is very enthusiastic in the way she shows she loves people? *

Not at all

Somewhat

Very

I want my dog to be playful? *

Not at all

Somewhat

Very

I want my dog to be laid back? *

Very

Somewhat

Not at all

I am comfortable doing some training with my dog to improve manners such as jumping, stealing food, and pulling on the leash? *

No training

Some training

A lot of training

I (or my children) want to participate in Agility or Obedience with our dog? *

NO

YES

It's most important to me that my dog . . . *

I am interested in a dog with "special needs" (medical or behavioral)? *

NO

YES

Thank you for completing the survey! We will evaluate your answers and get back to you by phone or email within 48 hours. A meeting will be scheduled at that time. Please be prepared to:

Be able to get together within 72 hours of our call/email
Be prepared to spend 20-30 minutes getting to know your potential pet
Be ready to take your new pet home if the meeting results in a positive connection (Unfortunately we are unable to set up multiple meetings).

Thanks again for your interest in adoption at Pet Central Helps!

YOU ARE NOW READY TO Press Submit Form Below Now!

Children over 8 years old	Children under 8 years old	Elderly People	Cats
Animals other than dogs and cats

In the garage	In a crate in the house	In the yard	Loose in the house
Confined to one room in the house