Académique Documents
Professionnel Documents
Culture Documents
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?_________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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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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