Medina County Society for the Prevention of Cruelty to Animals

Adoption Questionnaire

The purpose of this questionnaire is to help the SPCA match the right person with the right pet.  Animals, like people, have a variety of personalities and we want both you and the pet to be comfortable and satisfied.  Most of the animals that we are adopting have been either neglected or abused, and require some adjustment period in a new home.  Naturally, we want to be sure that they are placed in homes where both people and pets will be happy together.  We appreciate your cooperation by filling out this form completely.  Please do not leave any questions unanswered.

Do you own your own home or do you rent?___________________

**If you rent, the SPCA needs written permission or a copy of the lease agreement from your landlord allowing pets BEFORE you can take an animal home**

Type of residence you live in (House, Farm, Apartment, Condominium): _______________

Does your  home have a large yard or a small yard?________________________________

What type of outside containment do you plan to use (i.e. Fenced Yard, Trolley Run, Leash, Other(explain))? _________________

If Fenced yard, how high and what type of fence?_______________________________________

Do you currently own any other pets or are any other animals currently living in your home?_________

If yes, dog/cat and name(s): ______________________________________________________

Are your current pets living indoors, outdoors, or both?_________________________________

If any live outdoors, please explain:_________________________________________________

Are your current pets spayed/neutered?  Yes__________  No___________

If not, please explain why:________________________________________________________

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If you do not currently own a pet, have you ever owned any before?  Yes_________  No_________

If yes, please list them by type and name:_______________________________________________

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What happened to your former pets?___________________________________________________

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What Veterinarian Clinic were they under the care of (Name and Phone #)?

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From what years did you care for your former pets and how old were they when you received them?

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Is there a different name or address we should look under when calling the Veterinarian's office about your past pets?__________

If yes, what name or address should we use?________________________________________________

Ages and number of children living in your home (If applicable):_________________________

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Any allergies to pets in your family (If yes, please specify):_____________________________

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Why do you want to adopt a pet?_________________________________________________________

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Please list two personal references.  Include name, phone #, and relationship *CANNOT USE FAMILY MEMBERS*

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Name and phone # of Veterinarian who will care for this animal:________________________________

How many hours will the animal be left alone daily? _______________________________

If you are interested in a puppy or dog, please answer the following:

     Do you plan on attending obedience classes?  Yes__________  No__________

     Do you have a crate/cage, or do you plan to purchase one?  Yes__________  No__________

Where will the pet be kept during the day while you are home?_________________________________

Where will the pet be kept while you are away from home?____________________________________

Where will the pet sleep at night?_________________________________________________________

How will the pet be cared for while you are gone on vacation? _________________________________

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What method of housebreaking will you use?_______________________________________________

(If you need to learn how to housebreak a pet, we will be happy to teach you or provide you with the name of a professional trainer.  Remember....it takes time and patience, and some accidents will happen).

I understand that the SPCA requires the above information to insure that the animals are placed in the right home.  I certify that the above information is true and I understand that the SPCA will reclaim the animal if they discover that any of the information is not true or if any part of the Adoption Contract is violated.

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How did you hear about this animal?

Internet_______  Friend________  Adoption Center________  Newspaper________  Other________