DOG INFORMATION

Dog’s breed(s):

Dog’s color(s):

Dog’s name:

ADOPTER(S) INFORMATION

List Full Name(s) of all adults in home

Home address: street, city, state, zip

Mailing address: street, city, state, zip

Email address

Number of adults in home

Number of children in home

Work phone

Cell phone

Home phone:

Quiet Moderately Active Active Very Active

Select the activity level of your household

yes no

Have you ever adopted a pet from a shelter or rescue group?

yes no

Ever surrendered an animal to a shelter or rescue group?

If yes, when and for what reason?

yes no

yes no

Do you currently own a dog(s)?

Spayed/Neutered?

If yes, describe breed, age and temperament

yes no

Do you have any other pets?

If yes, describe breed, age and temperament

What animals have you had in the past?

What would cause you to return animal to UAF?

RESIDENCE INFORMATION

own rent lease

house condo apartment mobile duplex other

Residence

Type

If you rent or lease enter Landlords full name and phone number

How Long at Present Address

Plan to Move
in Near Future?

Community Covenant-
Controlled or Restricted?

If so, is there a breed or size restriction?

yes no

yes no

yes no

Do you have a fenced yard?

Fence Height?

Fence Size (WxL)?

Fencing Material?

yes no

Chainlink No Climb Wood Block Electric other

Describe any hazards (swimming pool, spa, shrubs, etc.) and how the dog will be protected from them:

DOG CARE AND HOUSING

Who is the dog for?

Why do you want to adopt this dog?

Who will be responsible for the care of the dog?

Who will be responsible for the training of the dog?

What Brand of dog food will the dog be fed?

How often will the dog be fed?

Once daily Twice daily Free Fed other

Where will the dog stay? During the day?

During the night?

During vacation?

How many hours will dog be without human companionship?

During the night?

During the day?

Will the dog be crated?

yes no

If yes, for what purpose, when and how long?

VETERINARIAN INFORMATION

Do you have a veterinarian?

yes no

Please list your veterinarian's name, address and phone number

CERTIFICATION OF INFORMATION

I agree to the following:
To contact United Animal Friends if I should become unable to keep the dog.
To a home visit conducted by a qualified United Animal Friends volunteer.
The need for screening of potential adopters and the understanding that United Animal Friends reserves the right to verify the information provided.
I certify that the information supplied on this interview is true and correct

Date

Date

Digital Signature

Digital Signature

ADDITIONAL COMMENTS AND/OR INFORMATION