Adoption Questionnaire Please note that submitting this questionnaire ensures that your information is in our database. It does not guarantee that you will be able to meet with a specific pet. What is your name?* First Last Email address* What is your mobile or home phone number?*Mobile number is preferred for texting capability.Address* Street Address City Zip Code AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State County (Multnomah, Washington, Clackamas, Clark, etc.) What is your date of birth?* MM slash DD slash YYYY What type of residence do you live in?*HouseDuplexTownhouse/RowhouseApartment – interior entranceApartment – exterior entranceOtherDo you have a fully fenced and secure yard?*YesYes, but it is a patioNoDoes not applyAges of any children (under 18) that would have regular contact with this pet? Please write N/A, if none.* Please check any other pets you have in your home currently or that would have regular contact with this pet. Please check N/A, if none.* spayed/neutered canine unspayed/unneutered canine spayed/neutered feline unspayed/unneutered feline small animal/pocket pets other N/A Please specify the age and breed of your pet(s).* Previous animal experience*Childhood petsFirst time pet parentHave had 1-3 petsHave had many animalsPlease specify the species of pets you have had.* Time spent away from home (usually)*Home all dayAway part time 4-7 hoursAway full day 7-10 hoursOtherWhere will this pet be during the day:*IndoorsOutdoorsIndoors with outdoor accessOtherWhere will this pet be during the night:*IndoorsOutdoorsIndoors with outdoor accessOtherWhich types of medical conditions do you NOT wish to take on? Please check all that apply. Chronic skin/ear conditions Potentially chronic bladder issues Blindness Deafness Diabetes Joint/bone issues – surgical Arthritis – chronic Dental disease – may need cleaning/extractions FIV+ Ringworm exposed/treated Which types of behavior challenges do you NOT wish to take on? Please check all that apply. Overstimulation Bite history on human Known house training/litter box issues Fear and/or anxiety Resource Guarding: protective of high value items Which types of behaviors are you looking for? Must be good with children Must be good with cats Must be good with dogs Can go out to crowded public areas/high traffic areas What would you like more information on: Training classes House/litter box training Medical care Nutrition Pet introductions Introductions to children Appropriate toys Is there anything else you'd like information on? If you require language interpretation services, please select your preferred language below. Arabic Cantonese French German Italian Japanese Korean Mandarin Persian Portuguese Russian Spanish Vietnamese