Message Contact Form

Name of pet:
Questionaire

Please answer the following questions to ensure the adoption is in the best interest of you and the pet.
Name*

First NameLast Name
Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home/cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Do you?

ownrent
Landlord's Phone

Area CodePhone Number
Landlord's Name:
Number of persons in your household
Anyone under the age of 18?
List ages of all members in the house:
List all current pets

Check all that apply
Dogs

FemaleSpayedMaleNeutered
Breed
Dogs

FemaleSpayedMaleNeutered
Breed
Dogs

FemaleSpayedMaleNeutered
Breed
Cats

FemaleSpayedMaleNeutered
Breed
Cats

FemaleSpayedMaleNeutered
Breed
Cats

FemaleSpayedMaleNeutered
Breed
Other

FemaleSpayedMaleNeutered
Breed
Other

FemaleSpayedMaleNeutered
Breed
List Previous pets
Dogs

FemaleSpayedMaleNeutered
Breed
What happened to it? (date of death)
Dogs

FemaleSpayedMaleNeutered
Breed
What happened to it? (date of death)
Dogs

FemaleSpayedMaleNeutered
Breed
What happened to it? (date of death)
Cats

FemaleSpayedMaleNeutered
Breed
What happened to it? (date of death)
Cats

FemaleSpayedMaleNeutered
Breed
What happened to it? (date of death)
Cats

FemaleSpayedMaleNeutered
Breed
What happened to it? (date of death)
Other

FemaleSpayedMaleNeutered
Breed
What happened to it? (date of death)
Describe operations or major procedures your pets have had:
Lifestyle
What hours is somebody usually at home?
Explain a typical week in your household. Example: Monday work, grocery store, kids soccer, ballet, home
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Housing
Where do you live?

CityCountry
Type of dwelling?

HouseTownhouseApartmentMobile Home
Fenced yard?

YesNo
Type of fence
Describe your home and yard
Vehicles
Year
Make
Model
Tag#
Year
Make
Model
Tag#
Year
Make
Model
Tag#
Explain how you transport your pets
Introductions
How would your pets get along with other dogs?
Explain the personalities of your other pets
How would you introduce a new pet into your household?
Veterinarian
Type of heartworm preventative used for current/previous dogs?
Describe heartworm medicine:
Name of veterinarian
Phone

Area CodePhone Number
May we contact your vet as a referral?

YesNo
Other
Why do you wish to adopt a new pet?
Does your family support this decision to bring a pet into your home?
Are you willing to commit to a pet for 10-15 years (average life span)?
Where will your new pet spend most of its time?
I hereby certify that the information provided is true and accurate. I hereby authorize Tallahassee Big Dog Rescue to contact any persons listed for references and verify all information.
Signature*
Date

MonthDayYearHourMinutesAM/PM Option
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