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Balooja's Foundation PRE Adoption Pet Application Questionnaire
A 501(C)(3) Rescue Organization
Sal Valdepeña: 323-823-3891
154-A West Foothill Boulevard Upland, California 91786 sal@baloojasfoundation.com | www.baloojasfoundation.com | PayPal: baloojasfoundation@gmail.com
Contact Information
Full Name
Occupation
Address
How long at this address
Daytime Phone
Evening Phone
Best time to call
Email address
Family and Housing
How many adults are there in your family (their relationship to you)?
How many children (ages?)
What type of home do you live in? Single family? Town home? Apartment? Farm? etc?
Please describe your household? Active? Noisy? Quiet? Average?
If you rent, please give the rules governing pets and the landlord's name and number.
(By providing this information you are allowing Balooja’s Foundation to contact your landlord please inform them of this call so they will speak with us)
Does anyone in the family have a known allergy to dogs?
Is everyone in agreement with the decision to adopt a dog?
Do you have time to provide adequate love and attention?
Other Pets
What other pets do you have (specify type and number)?
Are these pets up to date on vaccines?
Please specify if necessary
Are these pets spayed/neutered? If not, why?
Have you every surrendered a pet? If so, why?
Have you ever had a pet euthanized? If so, why?
Have you ever lost a pet to an accident?
How do you discipline your pets and why?
Veterinarian
Do you have a regular veterinarian?
Yes? Or No?
Veterinarian's Name
Clinics Name
Clinics Address
Clinics Phone Number
Clinics Phone Number
Providing Balooja’s Foundation with this information you are allowing Balooja’s Foundation to call your vet. Please call your vet and ask them to authorize the release of information to Balooja’s Foundation.
About the Dog You Wish to Adopt
What is your idea of an ideal dog and why?
State desired AGE, desired SIZE, and desired BREED
What breed would you not be interested in adopting?
Tell us briefly why?
Which are you interested in? Spayed female? Neutered Male? No Preference?
State your desire.
I prefer to adopt: Outgoing/high energy dog
State your desire.
I prefer to adopt: Shy dog
State your desire.
I prefer to adopt: Dog that needs regular medication
State your desire.
I prefer to adopt: Dog that needs training
State your desire.
I prefer to adopt: Dog that needs grooming
State your desire.
I prefer to adopt: None of the above kinds of dogs
State your desire.
In your own words, what kind of dog would you prefer to adopt and why?
State your desire.
Where will the dog spend the day?
Please describe
Where will the dog spend the night?
Please describe
How many hours on average, would the dog spend alone?
Please describe if necessary
Who will have primary responsibility for this dog's daily care?
Please describe if necessary
Who will have financial responsibility for this dog?
Please describe if necessary
Do you agree to provide regular health care by a Licensed Veterinarian? Yes? or No?
Please describe if necessary
Do you agree to keep the dog as an indoor dog? Yes? or No?
Please describe if necessary
When the dog goes out, how do you plan to supervise it? Fenced yard?
Please describe if necessary
Do you agree to contact Balooja's Foundation if you can no longer keep this dog?
Yes or No? Please describe if necessary
Are you willing to let a representative of Balooja's Foundation visit your home by appointment?
Yes or No? Please describe if necessary
How did you hear about Balooja's Foundation?
Would you be interested in Fostering?
Personal References
1) Please list someone who is familiar with both you and your pets.
Please list NAME, ADDRESS, PHONE NUMBER, and relationship to you? (ex: friend, partner, neighbor, relative...)
2) Please list someone who is familiar with both you and your pets.
Please list NAME, ADDRESS, PHONE NUMBER, and relationship to you? (ex: friend, partner, neighbor, relative...)
All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.
Apply now
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