Please answer ALL of the following questions by HC121106005616


									Please answer ALL of the following questions. Upon completion please return to Small Dog
Rescue of MN. (

Full name:


City:                                            State:                  Zip:

Home Phone:                    Work Phone:

Number of hours you work:

Names and ages of all children living with you:

Who besides immediate family, resides with you?           Please name them and list their ages:

Do you own or rent?

If you rent, please provide the name and phone number of your landlord:

Is this a house, duplex, condo, townhouse, apt, or mobile home?

How long have you lived at current residence:

Do you know the city animal ordinances/licensing procedures?

Do you have a fenced yard?

If yes, what type of fence is it and how tall?

If you do not have a fenced yard, explain how you will allow for the dog to relieve itself.

Do you have a pool? Is it fenced separately?

Will the dog be kept inside or outdoors? inside

Please explain where/how dog will live and what a typical day would be for the dog:
How many hours per day will the dog be left alone or crated?

Do you have an appropriate size crate/kennel for the dog?

If not, are you willing to purchase one?

Do you currently have any pets?

If yes please describe them in detail, ages, breeds, health, whether spayed or neutered,
Current on shots, what training they have received and what their diet consists of:

Please list any previous pets you have had in the last 10 yrs and where they are now/what happened
to them:

Please explain why you are interested in this dog breed or breed mix?

Please explain what you like about this particular dog                (name of dog)

What steps have you taken to learn about this breed/and or dog ownership?

What behavioral and or training issues can you “not deal with”?

If you were to return this dog to us for any reason or reasons what might they be?

If, for any reason, you are unable to keep this dog, will you agree to return it to SDR?

Would you allow a volunteer of SDR to make a preliminary home visit and follow-up?

Does any person residing with you in your home have any allergies?

Please provide the name and phone # of your vet:

Please provide the names, addresses, and phone# of THREE other references:

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