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Adoption Questionnaire

If you are interested in adopting a Second Chance at Love dog we would appreciate you filling out and submitting this on-line form so we can get to know you a little better and make sure that you pick the right dog for your environment and lifestyle. Please fill out this form in it's entirety. Thanks!


NOTE: It is better to use the Tab key than the mouse to go from field to field to avoid Repetitive Stress Injury- and it's faster... You can also use Shift + Tab to go back a field.

Your email address:

Your name:

Spouse/Roommate(s) name:

Second Chance dog you are interested in:

(OR) Breed of dog you are interested In:

Your address:




Home phone #:

Work phone #:

Spouse's work phone #:

Your work hours and days:

Your spouse's work hours and days:

Rent or own home:

Landlord's name:

Landlord's address:

Landlord's phone #:

Do you have children?:

Children's ages:

Do you have cats?:

Are they altered?:

Do you have a dog or dogs now? (yes or no):

Breed (s)?:


Age (s)?:

Are they neutered?:

If you don't have a dog now, when was your last dog and what happened to that dog?:

Have you ever adopted or owned a dog that did not work out and you relinquished? (yes or no):

What was the reason for giving up the dog, how did you handle the Situation, and then where did the dog finally go?:

Name of your veterinarian?:

Phone # of your veterinarian?

Is your yard contained?:

Describe your yard:

Describe your fence:

Would or do you allow your dog inside your home?
Explain please:

Where would or does your dog sleep?:

Would you be willing to take obedience classes with your new dog? If no, please explain:

How will you discipline your dog?:

What will you do with your dog when you travel?:

How physically active are you?:

Do you have any allergies? If so, to what?:

Please list three personal references whom you have known for at least five years (include addresses and phone numbers).

Personal reference #1

Personal reference # 2:

Personal reference #3:

Any other comments for us?:

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