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 Name Last Name
Email *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home/cell Phone *

Area Code Phone Number
Work Phone

Area Code Phone Number
Do you?

own rent
Landlord's Phone

Area Code Phone 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

Female Spayed Male Neutered
Breed
Dogs

Female Spayed Male Neutered
Breed
Dogs

Female Spayed Male Neutered
Breed
Cats

Female Spayed Male Neutered
Breed
Cats

Female Spayed Male Neutered
Breed
Cats

Female Spayed Male Neutered
Breed
Other

Female Spayed Male Neutered
Breed
Other

Female Spayed Male Neutered
Breed
List Previous pets
Dogs

Female Spayed Male Neutered
Breed
What happened to it? (date of death)
Dogs

Female Spayed Male Neutered
Breed
What happened to it? (date of death)
Dogs

Female Spayed Male Neutered
Breed
What happened to it? (date of death)
Cats

Female Spayed Male Neutered
Breed
What happened to it? (date of death)
Cats

Female Spayed Male Neutered
Breed
What happened to it? (date of death)
Cats

Female Spayed Male Neutered
Breed
What happened to it? (date of death)
Other

Female Spayed Male Neutered
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?

City Country
Type of dwelling?

House Townhouse Apartment Mobile Home
Fenced yard?

Yes No
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 Code Phone Number
May we contact your vet as a referral?

Yes No
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

Month Day Year Hour Minutes AM/PM Option
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