Dog Adoption Survey | Humane Society of Louisiana

DOG ADOPTION SURVEY
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Email Address:
ABOUT THE DOG(S) YOU ARE SEEKING: If you are seeking a specific pet from our agency, please tell us his or her name and why you would like to adopt him or her:
If you don’t have a specific animal in mind, please tell us about the type of dog who might interest you, so we can recommend a perfect match:
I prefer: a male a female no preference
I prefer: a puppy a young adult adult senior no preference
Of course, they’re adorable. But, if you are interested in a puppy, will you happily work to train your new addition, even when he or she exhibits typical puppy behaviors, such as: urinating on and soilling the floor or carpet chewing up shoes, toys and furniture digging in the yard barking and yowling through the night jumping up and scratching your doors, other people and pets incessantly nipping your fingers and ankles, when teething Still think you can take it? yes no
This dog will live: primarily indoors, with outdoor exercise outdoors as a yard dog
In terms of dog’s breed or appearance, I would prefer a dog of this description:
I prefer a dog with an energy, activity and/or attentiveness level of this description. Please check all that apply: very playful and high energy laid back and easy going smart, well trained and/or able to learn commands very affectionate, expressive and responsive protective of the household most in need of a home
Please check all that apply. I want to adopt this dog: primarily as a pal and companion to provide security and help protect my family to primarily serve as a guard dog to accompany on fishing and hunting trips to teach my child or children responsibility as a gift for a loved one or someone special Please check all that apply. My dog will: never ride in my vehicle occasionally ride in my vehicle accompany me on trips to the park or store enjoy riding in the back of my truck sometimes be left unattended in the vehicle when I run errands Please check all that apply. My dog will get his or her exercise: in my yard on regular short walks on a long daily walk at the local dog park when my son or daughter walks him or her Is there anything else you’d like to tell us about the sort of dog you’d like to adopt?
ABOUT ME AND MY HOUSEHOLD
Do you currently live with pets? yes no
If yes, please describe them. Include details about their species, breed, age and temperment. Also let us know if they are spayed and/or neutered or microchipped. If you have one, please provide your veterinarian’s name and contact information. If you have had pets in the past, please tell us about them. Include details about their species, breed, whether or not they were spayed and or neutered and/or microchipped. Also, please let us know if they passed away, if they were lost or something happened to them, or if they are living with someone else at present. Do you own or rent your place of residence? Rent If you rent, please provide your landlord’s contact name and information, if we can contact him or her: Tell us about your family or household. Please include details such as the names and ages of your family membes or housemates, as well as their relationships to you. Is everyone in agreement to adopt a dog as described above? Yes No I would best describe my home as a: Trailer Apt/Condo Small House Large House I would best describe the noise and activity level in my household as follows: Low Medium High In terms of housekeeping, I would best describe my household as: Cozy/Lived In Neat and tidy Immaculate If there are any pet behaviors that you or any of your household members will not tolerate, please describe them. If a new household member arrived at your residence, and that person feared, disliked or was allergic to this pet, what would you do? If your pet became lost, what would you do to find him or her? What will you do with your pet, if you are forced to evacuate, as the result of a hurricane or other natural disaster? If this is an out of state adoption, please indicate the manner in which you would prefer to take custody of the pet: Sponsor the cost of my pet’s air transportation Travel to Louisiana to pick up my pet Accept custody of the pet, when he or she is delivered by the HumaneSociety of Louisiana or cooperating local shelter If you could not continue to keep this pet for any reason, would you agree to return him or her to us, even if the pet is located in another state at that time? Yes No Are you agreeable a pre-adoption home visit at your residence, before you take custody of this pet. Yes No If you would like our Adoption Counselor to speak with you about any of the following topics, please indicate them: What to feed my dog and how often Introducing your new dog to your other pets Introducing your new dog to other family members Boarding or other care options for your dog, when you are out of town Obedience training Bad habits, such as jumping up, counter surfing, scratching furniture, etc. Is there anything else you would like to discuss with us concerning this adoption? Thank you SO much for taking the time to complete this survey!! An Adoption Counselor will be in touch with you soon. We’ll do our best to match you with the perfect dog, who best suits your lifestyle and would thrive in your household.