ADOPTIONQUESTIONNAIRE

NorthernCaliforniaSledDogRescue
P.O.BOX5784
Vallejo,CA94591
WWW.NORSLED.ORG
EMail:RESCUE@NORSLED.ORG
18004715822

EverypersonwhoadoptsaNorSledDogshouldbeawareoftheresponsibilitiesofdogguardianship,andshouldbecapableofand
willingtoacceptthoseresponsibilitiesmentally,physicallyandfinancially.Pleasebeawareofthebreedcharacteristicsandeducate
yourselfbeforeadoptingaNorthernBreedDog.PleasefeelfreetoaskaNorSledRepresentativeanyquestionsyoumayhave.
Bycompletingthisquestionnaire,youwillaidusindeterminingifyouandyourfamilyareafitforthedogyouareinterestedin,and
ifthedogofyourinterestwouldsuityouandyourlifestyle.
Pleasebeascompleteaspossibleandprintclearly.
Iffillingoutinwordtosendbyemail,pleasebackspacetotypeanduseXsandunderlinestocompleteclearly.

DOG(S)OFINTEREST:_________________________________________________________________Date:__________________

PERSONALINFORMATION

Name:___________________________________________________________________________________Age:______________
Nameofspouse/partner/roommate:_____________________________________________________________________________
StreetAddress:______________________________________________________________________________________________
City:__________________________________________________________________State:________ZipCode:_______________
HomePhone:_________________________________________CellPhone:_____________________________________________
WorkPhone:_________________________________________EMail:_________________________________________________
Occupation:_________________________________________SpouseOccupation:_______________________________________
WorkSchedule:______________________________________SpouseWorkSchedule:____________________________________
Namesofallpersonslivinginyourhousehold,theirrelationshiptoyouandtheirages:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Pleaselisttwopersonalreferencesandtheirrelationshiptoyou:
Name:_______________________________Relationship:__________________________Phone:__________________________
Name:_______________________________Relationship:__________________________Phone:__________________________

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ADOPTIONQUESTIONNAIRE

YOURHOME

Typeofdwelling?House___Condo___Apartment___Other___________Doyou:Own___orRent___

Ifnotahomeowner,doyouhavethelandlordspermissiontohaveadog?_____________________________________________
Arethereweightlimitsorbreedspecificrulesconcerningdogs?_______________________________________________________
Landlordsname:________________________________________________________Phone:______________________________
WillyouallowaninspectionofyourhomeandyardareasbyaNorSledRepresentative?___________________________________
Pleasedescribeyouryardareasandotherareaswhereadog(s)wouldbeallowedaccesstoincludingthetypeoffencingandheights
offencing.__________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

YOURCAMPANIONANIMALS

CURRENTDOG(S)
NameandBreed Age Sex Altered? InorOut Howyouacquiredhimorher? Howlonghaveyouhadhimorher?

OTHERPETS
NameandBreed Age Sex Altered? InorOut Howyouacquiredhimorher? Howlonghaveyouhadhimorher?

PREVIOUSDOG(S)
NameandBreed Age Sex Altered? InorOut Whathappenedtohimorher? When?

Haveyouevertrainedadoginobedienceclasses?_________________________________________________________________
Haveyouevertrainedadog?________Ifyes,whatmethodsoftrainingdidyouuse?_____________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
DoyouhaveNorthernBreedexperience?(explain)_________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________

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ADOPTIONQUESTIONNAIRE

YOURNEWDOG

Whowouldberesponsibleforthecareofthedog?__________________________________________________________________
Whatisyourprimaryreasonforadoptingadog?____________________________________________________________________
Ifforacompanion,whose?_____________________________________________________________________________________
Wherewouldthedogsleep?Inside___(where?___________________)Outside___(where?___________________)

Howmanyhoursperdaywouldthedogbeleftalone?_______________________________________________________________
Wherewouldthedogbewhenleftalone?Indoors___Outdoors___

Ifindoors:freeroam___crate___secludedroom___Other_______________________________________________________

Ifoutdoors:Yard___Kennel___DogRun___Garage___Patio___Other__________________________
Size:(_______)Size:(_______)Size:(_______)

Ifyard:Fenced___Unfenced___Other__________________________Doyouhaveadogdoor?Where?______________
(_____height)
Wherewillthedogbewhenyouareathome?alwaysindoors___mostlyindoors___alwaysoutdoors___mostlyoutdoors___

Howdoyouplantoexerciseyournewdog?_______________________________________________________________________
Ifnecessary,wouldyoubewillingtoattendobediencetrainingclassesatyourownexpense?______________________________
Doyoutravelagreatdeal?___________Howoften?________________Howlongatatime?______________________________
Whenyoutravel,howdoyouintendtoprovidecareforthedogwhenyouaregone?______________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Whatprovisionswouldbemadeforthedogifyouhadtomove:
Locally?_____________________________________________Outofstate?____________________________________________
Toaplacewherenopetsareallowed?____________________________________________________________________________

(Belowpleaseunderlineanythatapply)
Underwhatcircumstanceswouldyounotkeepthedog?DivorceIllnessinfamilyMovingNewbabyNewjobAllergy

HousetrainingproblemsChewingDiggingSheddingBarking/HowlingDoggrewtoobigDogbecameillKidsignore

PetsdidntgetalongNotobedientenoughOther______________________________________________________________

Wouldnotgiveupforanyoftheabovereasons.

Whatwouldyoudowiththedogifyoucouldnotkeephimorher?ReturntorescueTaketoshelterGiveawaySellthedog
Other______________________________________________________

Whatwouldyoudoifthedogbecamedestructivetoyourhome?______________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Willyouprovidemonthlyheartwormandfleapreventatives?YesNo
Ifthedogbecomesillorinjured,areyoufinanciallypreparedtoprovidethemedicalcare?YesNo
Ifyes,isthereamaximumamountyouwouldspendforyourdogsmedicalneeds?
$______________Reason_____________________________________________________________________________________

Thedogmaylive15+years,whatwouldyoudoifyoucouldnolongercareforthedog?____________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________________
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ADOPTIONQUESTIONNAIRE

Isthereanythingelseyouwouldliketotellusaboutyourself?_________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

Onceyourquestionnaireislookedover,youwillbecontactedwiththestatusofthedog(s)ofyourinterest.Atthattimeifheorshe
isavailableforadoptionwewillscheduleanappointmenttohaveyoumeetthedog(s).Wewillthen,atthesametimeoranother
scheduleahomeevaluationifyouarestillinterestedinadopting.

Questionnaireinformation:AlloftheinformationIhaveprovidedinthisquestionnaireistrueandcorrect.Ifanyoftheinformation
changesIwillnotifyNorSledpromptly.

PrintName:______________________________________________________________

Signature:________________________________________________________________Date:______________________________

NorSledUseOnly:

Questionnaireacceptedby:__________________________________________________Date:_____________________________

NorthernCaliforniaSledDogRescue
P.O.BOX5784
Vallejo,CA94591
WWW.NORSLED.ORG
EMail:RESCUE@NORSLED.ORG
18004715822

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