Regional Animal Protection Society

Dog Adoption Application

Contact Information

Questionnaire

Contact Information

Date

Dog's Name

Your Name Hereinafter referred to as the 'Adopter'

Phone Number

Cell Number

Address

City

Province

Postal Code

Personal Reference Name (Not a family member)

Reference Phone Number

Relationship

How long have you known each other?

Please complete the following questionnaire in its entirety. Our main objective is to ensure good compatibility between you, your family, and your new pet.

Do you own or rent your residence?

Own

Rent

If you rent, do you have your landlord's permission to have a dog?

Yes

Landlord's Name & Phone Number

What type of home do you live in?

House

Apartment

Condo

Townhouse

Trailer

Other

If you entered other, please describe:

How long have you resided at your current address?

Is this going to be your first dog?

Yes

If no, what kind of dogs have you previously owned?

Where did your previous dog spend their time?

Indoors

Outdoors

Indoors & Outdoors

If this is not your first dog, what happened to your previous dog?

Please list your plans for this dog:

Companion

Outdoor Guard

Indoor Protection

Hunting

Obedience

Agility

Other

If you selected other, please explain:

Do you have a regular veterinarian?

Yes

If yes, please provide your vet's name and phone number

Are you 25 years of age or over?

Yes

Who will be the primary caregiver of the dog?

Occupation

Do you have reliable transportation?

Yes

Are all family members in agreement about adopting a dog?

Yes

How many people reside in your home?

Are there any children residing in your household?

Yes

If yes, how many and what ages?

Does any family member suffer from allergies?

Yes

Do you currently own any other animals (including livestock)?

Yes

If yes, please list:

Are they spayed or neutered?

Yes

If you have other pets, how do you feel they will adjust to a new dog in the house?

Do you have a fully-fenced yard?

Yes

If yes, what is the height and type of fence?

Do you have a separate kennel run?

Yes

If yes, list height and size:

If yes, is there a dog house in the run?

Yes

If yes, how often will you use this run?

On average, how many hours a day will the dog be left alone?

Where will the dog spend the day when you are NOT home? (check all that apply)

Loose indoors

Loose outdoors

Tied up outdoors

Kennel run

Fenced yard

Basement

Garage

Where will the dog spend the day when you ARE home? (check all that apply)

Loose indoors

Loose outdoors

Tied up outdoors

Kennel run

Fenced yard

Basement

Garage

Where will the dog sleep at night? (check all that apply)

Loose indoors

Loose outdoors

Tied up outdoors

Kennel run

Fenced yard

Basement

Garage

If you answered BASEMENT to any of the above questions, please answer the following three questions:

Is your basement finished and used by the family?

Yes

Will the dog be alone in the basement?

Yes

Will the dog be allowed to go upstairs when the family is upstairs?

Yes

How do you plan to exercise your dog and see to its toilet needs?

How much time per day can you commit to exercise your dog?

What will you feed this dog?

Dry food

Wet food

Raw food

Other

Have you considered the financial responsibilities of owning a dog?

Yes

How much do you expect the cost to be monthly?

Do you feel you can commit to a dog for the next 10 to 20 years?

Yes

If you were to go on vacation, where would the dog stay?

If you were to move in the future, what would happen to the dog?

Are you willing to take this dog to positive-method obedience classes?

Yes

Are you able to provide proper medical care for your dog as required?

Yes

Are you in agreement with the rule that if you can no longer keep the dog, you are required to return it to RAPS?

Yes

Have you ever surrendered or rehomed an animal?

Yes

What would the number one reason for you to return the dog?

What is your opinion of using a crate for training purposes?

Your dog refuses to obey a command. How would you handle this?

If you returned home to find that you dog has chewed your furniture what would you do?

If your dog urinated/defecated on the floor what would you do?

Animal Control Services are concerned for the well being of all shelter dogs. Would you be willing to allow one of our staff members to do a scheduled home visit prior to, and/or after the adoption process?

Yes

I certify that all the information I have provided is true and correct.

Yes