Adoption Questionnaire | Dog Harmony, Inc.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Do you own or rent your home?*

Own
Rent

Have you owned a dog before?*

Yes
No

The last time I had a dog was **

I need a dog who gets along with other dogs*

No
Yes

If you answered yes to the previous question, please list the names, ages, genders and breeds:*

My dog needs to be good with (check all that apply)*

Children over 8 years of age
Children under 8 years of age
Elderly
Cats
Animals other than dogs and cats

My dog will primarily be*

An indoor dog
An outdoor dog

How many hours per day will your dog spend outside?*

What kind of collar/harness will you use to walk your dog?*

My dog will be alone each day for:*

When I'm at home, I want my dog to be at my side*

The majority of the time
Some of the time
Little of the time

When I'm not home, my dog will spend the majority of the time*

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 very enthusiastic in the way it 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 manner correction training*

None
Some
Very

I want to participate in Agility, Flyball, or Obedience classes with my dog*

Yes
No

I'm interested in a dog with special needs (medical or behavioral)*

Yes
Possibly
No

It's most important to me that my dog:

Please provide us with your current/previous vet's name and phone number.

Phone Number*

Please provide us with two personal references and your relationship to them. First Reference:*

Phone Number*

Second Reference:*

Phone Number*

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