Name (First & Last):
*Email Address:
Please note: if you use Spamblocker or another program, be sure to include info@retrieversandfriends.com in your "ALLOWED" list.
Home Phone:
Work Phone:
Address:
City:
State: CA
Zip:
Number of people who reside in your home:
???
0
1
2
3
4
5
6
7
Ages of people who reside in your home:
Your Employer:
Spouse's Employer:
What is your work schedule?
???
Full Time
Part Time
Work from home
Not Employed
About Your Home
Do you live in a:
???
House
Apartment
Condo or Townhouse
Mobile Home
How long at this address?
Do you rent or own your home?
Landlord's Name (if applicable):
Landlord Phone:
Does your rental agreement allow you to have a pet?
Does anyone in your family have allergies?
???
No
Yes
If yes, please explain below:
What is your household activity level?
Quiet
Active
Very active
Do you have a local veterinarian?
Yes
No
If yes, please list name and phone number below:
May we call your veterinarian for more information?
???
Yes
No
Name of dog(s) you are interested in (from web site):
How long have you been looking for a pet?
Just started
A month or more
Six months or more
What age of dog would you like to adopt?
Would you like to adopt a male or a female?
Breed:
Size:
Color:
Why are you interested in adopting this particular breed of dog?
How soon are you ready to adopt?
If this dog chews, digs, or has any bad habits, what will you do?
Under what circumstances would you consider giving away your dog to a new owner?
Who will be responsible for the care and feeding of this dog?
What brand of dog food you plan on feeding this dog?
What arrangements would you make for the this pet when you travel?
Kennel
Pet Sitter
Friends, family, or neighbors will provide care
We will take our pet with us
We do not travel
Do you have any upcoming travel or vacation plans?
If yes, when will you be leaving and how long will you be gone?
How will you exercise this dog?
Please describe your yard, including approximate size (small, medium, large), patios, or any landscaping or other details you feel are important.
Do you have a pool?
???
Yes
No
Does the pool have it's own fencing around it to prevent the dog from going into the pool when out in the yard? Please describe:
Do you have a secure fence that encloses your yard fully?
What type of fence do you have and how high is the fence over-all?
Many fences have varying heights at different points in the yard. What is the height of your fence at the lowest point (approximate measurement from the ground to the top of the fence).
What is the height of your fence at the highest point (approximate measurement from the ground to the top of the fence)
Where will this dog be kept during the day while you are gone?
How many hours are you usually gone during the day?
Where will the dog be when you are home?
If it's raining outside, is there a covered area where the dog can stay dry? Please describe.
What type of shade is there in your yard for your dog during the summer months?
Where are your water, gas and electric meters located in your yard? Do meter readers need to access your yard while you are gone?
Do you have a gardener or any other person that enters your yard during the day while you are not at home?
Where will the dog sleep at night?
If indoors, how do you plan on housebreaking your new dog (if not already done)?
Your Pet History
Please provide the following information for any pets you now own or have owned in during your adult life. You may add additional pets in the "comments" section below.
Pet #1
Breed
Age
Sex
Is your pet spayed or neutered?
Do you still have this pet?
If this pet is no longer with your family, please explain. (Cause of death, or to whom the pet was given and why.)
Pet #2
Breed
Age
Sex
Is your pet spayed or neutered?
Do you still have this pet?
If this pet is no longer with your family, please explain. (Cause of death, or to whom the pet was given and why.)
Pet #3
Breed
Age
Sex
Is your pet spayed or neutered?
Do you still have this pet?
If this pet is no longer with your family, please explain. (Cause of death, or to whom the pet was given and why.)
Pet #4
Breed
Age
Sex
Is your pet spayed or neutered?
Do you still have this pet?
If this pet is no longer with your family, please explain. (Cause of death, or to whom the pet was given and why.)
Pet #5
Breed
Age
Sex
Is your pet spayed or neutered?
Do you still have this pet?
If this pet is no longer with your family, please explain. (Cause of death, or to whom the pet was given and why.)
