Adopt A Pet

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SICSA Dog Pre-Adoption Survey

ASPCA Meet Your match Pre-Adoption Survey

I have owned a dog before	Yes No

I Currently Own a Dog	Yes No

The last time I had a dog was:

2-10 Years Ago

More than 10 Years Ago

Not currently, but within the last year

My New Dog needs to get along with my other dogs	Yes No	If yes, list their names, ages, genders and breeds

My new dog needs to be good with

(check all that apply)

Children over 8 years old

Children Under 8 years old

Elderly People

Cats

Animals other than cats or dogs

My dog will primarily be an:
Inside Dog Outside Dog

How many hours will your dog spend outside per day:

My dog needs to be able to be alone:

2 hours or less per day

4 hours or less per day

8-10 hours per day

12 hours per day

When I am at home, I want my dog to be by my side:

All of the time

Some of the time

Little of the time

When I'm not at home, my dog will spend it's time

In the garage

In a crate in the house

In the yard

Loose in the house

Confined to one room of the house

I want a guard dog: Yes No

I want my dog to hunt or herd with me: Yes No

I want my dog to be the type that is very enthusiastic in the way s/he shows s/he loves people:

Not at all Somewhat Very

I want my dog to be playful:

Not at all Somewhat Very

I want my dog to be laid back:

Not at all Somewhat Very

I am comfortable doing some training wtih my dog to improve manners such as jumping, stealing food and pulling on the leash.

No training Some training A lot of training

I (or my children) want to participate in Agility, Flyball or Obedience with our dog.

Yes No

I am interested in a dog with 'special needs' (medical or behavioral):

Yes No

How much do you think you'll spend yearly for the care of your dog? (Food, medical care, boarding, toys etc.)

Applicant(s) Contact Information

	Full Name	Age	Employer
Applicant
Co-Applicant

Residence Street Address (not a P.O. Box) :
City:
State:		Zip:
Home Phone:
Work Phone:
Cell Phone:
Years at current address:
E-mail Address:

Household Members - Other Than Applicant(s)

Name	Age	Relationship

Are you planning to supervise the dog at all times with children under the age of 10?	Yes No

If rent, landlord contact information:	Name:
Type (e.g. house, apartment, condominium, mobile home, etc.)	Rent Own
If rent, landlord contact information:	Phone:
How long do you expect to be at your current residence?
How will you contain the dog on your property?	Fence Tie out Dog run/kennel Other
If a fence, specify type and height:
If Other, please specify

What types of training problems would you not be able to accept?
How will you correct training issues?
Do you understand that rescued dogs may be house-training problems — especially at first?	Yes No

List any pets in the past 3 years that are no longer with you.

What heartworm preventative do you use?
Do all your pets receive regular veterinary care and are they up-to-date on vaccinations?	Yes No

Veterinarian Name :		Phone:

I have answered all the above questions truthfully to the best of my knowledge. I understand that if, for any reason I can no longer care for or keep the dog, I must notify SICSA immediately..

SICSA offers no guarantees regarding health, behavior, temperament or actions of the pet you are interested in adopting. If you choose to return the pet, the adoption fee is non-refundable and no refund will be given for any additional medical costs.

Type your full name here to acknowlege your understanding.