Name *

First Name

Last Name

Name of Spouse

(If applicable)

First Name

Last Name

Phone Number *

(###)

###

####

Spouse's Phone Number

(If applicable)

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate *

MM

DD

YYYY

Are you planning any of the following in the next month? *

Moving

Vacation

Change in Schedule

None

Are you ready to bring a dog home within the next 2 weeks? *

If not, please apply when you are ready to bring home a new furry friend

Yes

No

Did you meet this dog during our Sunday Open House? *

Yes

No

Are you open to other dogs? *

Yes

No

Are you open to adopting a bonded pair? *

Yes

No

Who are you adopting this dog for? *

Myself

My spouse

My immediate family

My extended family

Other

Any visiting children? *

Yes

No

Any dog allergies in the household? *

Yes

No

Maybe

What is the most accurate description of your neighbourhood? *

City

Busy Suburb

Quiet Suburb

Rural

What kind of home do you live in? *

House

Basement Apartment

Apartment

Condo

Acreage

What type of yard do you have? *

Fully fenced

Semi fenced

No fence

Electric fence

Stake in the ground with long line

Shared yard

No yard

Do you *

Own

Rent

If renting, do you have your landlord's permission to have pets? *

Yes

No

Not applicable

Where will the dog stay during the day when home alone? *

Crate

Loose in house

Garage

Backyard

In the house and outside through open door/dog door

Tied in the backyard

Section of the house

Own room

Outdoor dog run

Where will the dog stay during the night? *

Crate

Loose in house

Garage

Backyard

In the house and outside through open door/dog door

Tied in the backyard

Section of the house

Own room

Outdoor dog run

While at work are you planning on any of the following *

Hire a dog walker

Bring the dog to dog daycare

Have a neighbour or family member take the dog out

Walk before I leave for work and as soon as I come home

I am retired

I work from home

What is the main purpose of the dog? *

Companion for myself/my family

Companion for my current dog

Guard dog/protection

Competition dog

Working dog

Farm dog

Have you had dogs before? *

Yes

No

In my childhood home

Have you had pets (other than dogs) before? *

Yes

No

In my childhood home

Have you euthanized a pet before? *

Yes - for medical reasons

Yes - for behavioural reasons

No

Do you plan on purchasing pet insurance? *

Yes

No

Have you ever surrendered or given away a pet? *

Yes

No

What would you enjoy doing with the dog? *

Jogging

Off-leash parks

On-leash walking

Off-leash walking

Scent detection

Cycling

Competition training

Hunting

Are there other dogs in your household? *

1

2

3

4+

None

Are there other pets in your household? *

Cat

Bird

Rodent

Reptile

Fish

None

What gender of dog are you looking for? *

Male

Female

No preference

What type of coat/fur are you looking for? *

Short

Medium

Long

Non-shedding

No preference

What age are you looking for? *

Puppy

Adult

Senior

No preference

What size dog are you looking for? *

Small

Medium

Large

No preference

What problems are you willing to work with? *

Separation anxiety

Reactivity to dogs

Dog aggression

Excitability

Barking

Mild aggression

Vocalization

Obedience

House training

Fearfulness

I am not willing to work on any problems

Do you need a dog who is already trained? *

Yes

No

Are you open to adopting a dog with special needs or medical needs? *

Yes

No

Maybe

Have you done obedience training with a dog before? *

Yes

No

Do you have a lot of experience and think you can handle a difficult dog? *

Yes

No

If your dog required an emergency life-saving surgery that would cost $6,000-$8,000 with a 50% chance of survival, would you proceed with the surgery? (ONLY SELECT 1) *

Monitor the dog to see if it gets better

Pay for the surgery

Humanely euthanize the dog

Surrender the dog back to Dog Tales

Under which circumstances would you return your dog? *

Moving

Too costly

New baby

If the dog bit me

If the dog bit a stranger/visitor

If the dog bit a dog

Medical reasons with the dog

Not enough time

Behaviour problem

Destructive of the house

Accidents in the house

I would not return a dog

Have you ever been convicted of neglect or cruelty to animals? *

Yes

No

Are you willing to have a Dog Tales representative do a home visit by appointment? *

Yes

No

Date Signed *

MM

DD

YYYY