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ADOPTION ASSISTANCE QUESTIONARE PLEASE PRINT CLEARLY Name ___________________________________________ No. of adults in home (over 18) _______ Home Phone_________________________________ Work Phone _____________________________ Address _______________________________________________________________________________ Own ( ) Rent ( ) Double ( ) Apartment ( ) Condo ( ) Trailer Park ( ) Purchasing as a gift, Check here _____ Describe the type of dog you'd like (size, personality) Ages of children in home (under 18) ___________________________________________________ Person most responsible for care/training of dog ________________________________________ Dog will live mainly ( ) indoors ( ) outdoors Fenced yard?__________________________ Length of time dog or pup will be home alone during the day: __________________ hours Does anyone in household have allergies? ______________________________________________ Do you plan to move in the near future? ________________________________________________ Are you expecting a new baby/child in the near future? ___________________________________ Breed Sex Age Fixed? Licensed? How long owened? __________________ _____ _____ (Yes / No) (Yes / No) __________________________ __________________ _____ _____ (Yes / No) (Yes / No) __________________________ __________________ _____ _____ (Yes / No) (Yes / No) __________________________ Cats or other pets? ___________________________________________________________________ Do you have a veternarian? (Yes / No) ________________________________________________ Do current pets have all necessary vaccinations yearly? __________________________________ Have you owened any dogs in the past other than listed? ________________________________ I have read the Cuyahoga County Kennel Adoption Procedure sheet. I understand that dog ownership is a major responsibility and I am prepared to make the lifetime commitment to proper care, housing, training, YEARLY veterinary attention and YEARLY purchase of dog licence. I understand that the County requires that my adopted dog be spayed/neutered. If this surgery must be performed at a later time, I agree to return the dog as scheduled and not to relinquish owenership of the dog without first contacting the County Kennel. _____________________________________________________ ________________________ Signature Date - - - - - - - - - - - - - - - - - - - - Do Not Write Below This Line - - - - - - - - - - - - - - - - - - - - Employee: __________ Comments/Restrictions _________________________________________ All adults in home here __________ or agree __________ Children under 9 here ___________ Vet care verified for 2 or more dogs ____________ Other dogs here & licenced ____________ Landlord / condo / trailer permission _______________ Supervisor's approval _______________ CHOICE PLACED: ( 1 ) ( 2 ) Cage ______ Tag ______ Breed ___________________ Sex ______ Age ______ Adopted: Date _______ Breed ___________________ Sex ______ Age ______ |