Dog Questionnaire Application

Questionnaire - Application for Suruluna
Adoption Fees

Puppy (under 1 year) $ 400

Adult dog $ 300

Senior dog (OVER 8 years) $ 200
To Adopt a dog you must

- Be at least 18 years old

- Understand that Suruluna Animal Rescue reserves the right to deny the adoption of any pet for any reason.
Dog(s) you are interested in*
Adopter's Name*
First & Last Name
Co-Adopter's Name
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's E-mail*
Co-Adopter's E-mail
Phone Number - Home

Area CodePhone Number
Phone Number - Cell*

Area CodePhone Number
Names and ages of all permanent residents of your home (adults/children)*
Name and phone number of your employer*
Vet reference (please call your vet and give permission to release information to us)*
Vet name, address & phone number
Are you planning to move in the near future?*

YesNo
Are you willing to have Suruluna come for a home visit?*

YesNo
Will this be your first dog as an adult?*

YesNo
Current pets in your home: Name, Species, Ages, Sex, Spayed/Neutered*
Please list the kinds of pets that you had in the past. If you no longer have them, please list why.
Have you ever surrendered or re-homed your dog?*

YesNo
If yes, please give details
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhouseTrailerApartment
Do you rent or own this property?*

RentOwn
If you rent please provide the info (name and contact number, email) of your landlord/management - If you have a Condo/Townhouse please provide contact information for any management or Home Owner Association*
If you rent, we must have the authorization from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any specific limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.
Are you familiar with any regulations and restrictions regarding dogs in your home?*

YesNo
If you are not sure about the regulations Suruluna might ask for a copy of your lease and/or a written authorization from your landlord/management.
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhouse)
Do you work outside the home?*

YesNoOne applicant is home/works from home
How many hours per day will this dog be alone? *
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
We require that all household residents are aware of this application process and that they come to meet the dog prior to any final decision.

If you are approved to adopt and you already have another dog(s) you will also be required to bring the dog for an introduction.
Are you aware of the costs of caring for a dog for his life time? (Vet care, food, toys, possible training, pet boarding/sitting etc.)*
What activity level do you prefer?*

Puppy-like and high energy is coolLeash trained, daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potato
Please check all that apply. My adopted dog will...*

Be kept outside most of the timeBe kept indoors most of the timeBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenHave private sessions with a trainer as neededBe boarded when we go on vacationStay with family when we go on vacationBe going on trips with us
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

HousebreakingChewingFear of menFear of womenFear of childrenMouthinessBarkingHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleSeparation AnxietySpecial DietLong Term MedicationAllergies
What would you do if your dog was diagnosed with an expensive health condition?*
Two Personal references (no family members)
Please note that you will be adopting from a Rescue/Sanctuary and you will be required to sign an agreement that you will not euthanize the dog without consulting with Suruluna.
Please check this box, sign, and click Submit to confirm that you have read the above.*

I/We have read and understand all of the above.
Applicant's Signature*
Co-Applicant's Signature
Signature date*
After you submit this form we will review your application and get in touch to set up a visit to meet the dog(s) of your choice.
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Questionnaire - Application for Suruluna