AJs Best Friends Purebred Cat and Small Dog Rescue

Wednesday, September 08, 2010

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Matchmaker Questionaire

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Cat Questionaire

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Dog Questionnaire

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Thank you for taking the time to complete this form. This aids us in helping you find the best

match for your home. Please note, we do not sell or give your personal information to anyone.

* denotes a required field

Name of Dog(s) I want to adopt *
Name, Address, Phone #
Applicant Name,* First and Last
Co-Applicant Name, First and Last
Relationship
Home Email Address* * Please verify your email address is correct as all initial contact will be via email*
How often do you check this email account?
Work / Other Email Address
Street Address*
Lot / Unit / Apt #
Apt Complex / MH Park Name
City*
State*
Zip*
Daytime / Cell Phone*	* Please note, we will not return long distance calls*
Evening Phone
About you & your family
Have all adult household members been notified that you are looking to adopt a dog?*
Are they in agreement to adopt a dog at this time?*
Is anyone in your home allergic to dogs?*	Yes No
How many adults live in your home?*
How many children live in your home?*	What are their ages?
Do children visit your home? *	What are their ages?
If there are no children in the home at this time, are there plans for this to change during the dog's lifetime? *	Yes No
Who will be responsible for caring for the dog?*
About your Home
Type of home?*
Do you own or rent your home?* please note we do verify home ownership
Does your landlord allow animals?*	Yes No Not Applicable
Landlord name * required if renting
Landlord phone number * required if renting
Does your home have a dog door?*	Yes No
Does your home have a pool? *	Yes No
Does the pool have a separate fence? *	Yes No
Is the yard completely fenced on all 4 sides? *	Yes No
How high is the fence at the lowest point?*	ft
What type of fencing? *	if other then what type?
What type of side yard gate do you have?
How high is the side yard gate?
Is there concrete under the gate to prevent dog from digging out?	Yes No Not Applicable
What type of lock does the gate have? Use <Ctrl> to select more than one
Type of yard:*
Your Current &/or Former Pets
Have you had animals before?*
What kind? Use <Ctrl> to select more than one
Where are they now?
How many animals do you have now?*

Describe your current animals
	Type/Breed	Indoor/Outdoor?	Age	Gender	Spayed or Neutered?	Up to date on Vaccinations?
1st Animal
2nd Animal
3rd Animal
4th Animal
5th Animal

We regret that we cannot "hold" dogs for you. Please be prepared to
adopt and take your new dog home with you the day of adoption.

About your new Dog: (Select all that apply)
Include any characteristics you would be interested in. We may have other dogs not already listed.

Physical Characteristics

What age of dog are you looking for?
Use <Ctrl> to select more than one

What gender of dog?

Coat Length

Size
Use <Ctrl> to select more than one

Color

Breed(s)

Other Physical Charactersitics

Personality Characteristics

Activity Level

We want our new dog to do the following with us:
Use <Ctrl> to select more than one

Other Personality Characteristcs

How many hours per day do you work and/or attend school?

How many hours per day is someone home?*

What are your plans for housetraining? *

Where will your dog be kept while you are away?*

Where will your dog be kept during the during the night?*

When you are out of town, do you plan to:*
Use <Ctrl> to select more than one

If you would have to move, what are your plans for the dog?*
ie give to family/friends, take the dog with you, return the dog, find the dog a new home

Would you be willing to take your dog to obedience training?*

Yes No

Are you familiar with crate training?*

Yes No

Will you crate train?*

Yes No

How much are you willing to spend on
medical expenses per year for your dog?*

If medical expenses exceed your limit, how do you plan
to get your dog necessary medical procedures?*
note: this field is required for the form processer
even if "no limit" is selected above

If this is a small breed dog who requires regular grooming,
Are you willing to get the dog groomed every 6-8 weeks?*

Yes No

Would you consider adopting an animal with special needs?*

Yes No

What are your greatest concerns in getting a new dog? *
Housebreaking, Allergies, etc.

For what reasons would you return a new dog? *
ie Allergies,Moving,Change in Marital Status,
Pet Health issues, Personal Health Issues.
New baby, Not compatible with other pet,Job change,Kids not taking care of pet

Are you willing to adopt a dog who has been abused or not socialized and may be anxious or take a while to bond with you? *

Are you willing to adopt a dog who is not completely housebroken? *

Are you willing to adopt a dog who has on going medical needs? *

Are you willing to adopt a dog who is not reliable with children? *

If you are interested in a particular dog, then tell us why do you believe YOU are the best home for this dog?*

When will you be available to adopt a dog and take it home? *
i.e. today, this weekend, next month, after vacation,
when house is built in a few months, etc.

How long and where have you been looking for a new dog?*
Please include if you have applied to another rescue group and/or are looking at another dog

Reason for Adopting*
Use <Ctrl> to select more than one

Any other comments

How did you hear about our rescue?

Thank you for taking the time to fill out this form.
By signing below, you are indicating that you are at least 18 years old and the information supplied by you on the Adoption Questionnaire is accurate and truthful. Falsification of information or intentional misrepresentation of information in the Matchmaker Questionnaire is an immediate and permanent disqualification. Should an adoption take place, you also agree to abide by the terms and conditions specified in the Adoption Contract.

We regret that we cannot "hold" dogs for you. Please be prepared to adopt and take your new dog home with you the day of adoption.

Name* Date*

*Before hitting submit, ensure that all required fields noted by a * have been completed or the form will not submit *
*When the form is sucessfully submitted, a confirmation screen will display that the form has been sent.*
*When we receive this form, a confirmation email will be sent back to you, generally within 24 hours.
If you do not receive a confirmation email, please email adopt@jsbestfriends.org *

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