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Sample Shelter Forms
- 1. Cat Adoption Application
- 2. Dog Owner's Questionnaire (Relinquishment Profile)
- 3. Pet/Livestock Adoption Application
- 4. Dog Adoption Application
- 5. Cat Owner's Questionnaire (Relinquishment Profile)
- 6. Adoption Discussion Card - Dog
- 7. Reptile/Amphibian Animal Adoption Application
- 8. Questions to Review by Public Officials and Concerned Citizens
- 9. Adoption Discussion Card - Cat
Dog Owner's Questionnaire (Relinquishment Profile)
Marin Humane Society
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Dog Owner's Questionnaire
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Dog's Name: ______________ Breed: ___________ Age: _______ Sex: ________
To enable us to find the best possible home for this dog, please fill in the information below as completely and accurately as possible.
Why are you giving up this dog? _______________________________________
How long have you owned this dog? ____________________________________
Where did you get this dog? ___________________________________________
How many owners has this dog had? ____________________________________
What other types of pets did this dog live with? ____________________________
Please describe any conflicts with this dog and the other
pets? ________________
_________________________________________________________________
List ages of any children in household. __________________________________
Please describe any conflicts this dog had with the children. __________________
_________________________________________________________________
How many hours a day was this dog left alone? _______________________
Where did the dog spend most of his time?
Always outside r Mostly Outside r In Garage r Outside unless we were home r In a crate r In or out at will r Always inside r
Please describe how the dog reacted to being left alone. ___________________
How often does this dog urinate or defecate in the house? __________________
What form of daily exercise did this dog receive? ________________________
How did you confine this dog to your property? _________________________
r fence - what type? __________________ How high? __________
r kennel - what size? _______________ Completely enclosed? _________
r chain or tie out How long? ______________ Where? ______________
r invisible fence
r never outside off leash or unsupervised
r did not confine - dog would always come home
How often did your dog escape confinement? ________ How? ___________________
___________________________________________________________________
What type of obedience training has your dog had? ___________________
What commands does your dog respond to? ________________________
Have you ever consulted a trainer or behaviorist on any problems concerning this dog? ____
What kind of problems? ___________________________________________
How many times? ___________
Has this dog ever bitten or snapped at anyone? No r Yes r
Describe incident __________________________________________________
Describe any problems this dog has with the following:
Children _________________________________________________
Other Dogs _____________________________________________
Cats or wildlife __________________________________________
Strangers ______________________________________________
Other _________________________________________________
Is this dog overly protective of any of the following: (please give examples)
Food _________________________________________________
Toys _________________________________________________
Family members ________________________________________
Property ______________________________________________
Car __________________________________________________
Other pets _____________________________________________
What types of situations/things make your dog bark? ________________________
Has this ever created a problem? ________________________________________
What form of discipline or correction do you use with this dog? ________________
How does the dog react? ______________________________________________
Who is your dog's veterinarian? _____________________________________
What kind of health problems has this dog had? _________________________
What types of medications has it used? ________________________________
What type of flea control is your dog currently using? _____________________
What type of heartworm medication is your dog on? ______________________
Date of last dose? ______________________________________________
Is this dog on a special diet? Yesr Nor What Type? _________________
Describe your dogs idea of a perfect day? ______________________________
Courtesy of
171 Bel Marin Keys Blvd.
Novato, CA 94949
(415) 883-4621
(415) 382-1349 fax
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Pet/Livestock Adoption Application
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