<p>Section 2: About My Home Number of Adults: </p><p>Do they all work outside the home? Yes No Who will be the dog’s primary caretaker? Number of children: Age of children: </p><p>Do children frequently visit your home? Yes No If yes, age of children: </p><p>Is anyone in the family allergic to pets? Yes, to dogs and cats Yes, to cats only Yes, to dogs only No If yes, who in your family is allergic and how severely? </p><p>Is anyone in your home nervous or unsure of dogs? Yes No If yes, who? </p><p>Living circumstance: I rent my home I own my home I live with parents/relatives</p><p>If renting, does your lease allow pets? Yes No Landlord’s name and number: How long have you lived at this address: </p><p>My home is: In the city In the country In the suburbs In a mobile park Apartment/Condo Name of mobile park: Name of Apt/condo complex: </p><p>Will you allow an Animal Connections representative to do a pre-adoption visit to your home? Yes No Please list all pets in your household: Name Type/Breed Vaccinated (Y/N) Age Sex Spayed/Neutered Kept where? (Y/N)</p><p>Have you had other dogs or cats in the past 5 years? Yes No If yes, how many? Dogs Cats Where are they now? </p><p>Do you currently have a veterinarian? Yes No If so, name and phone number of current veterinarian. Name: Phone Number: Section 3: My Preferences</p><p>I am looking for (check all that apply) Puppy Young adult Senior No preference</p><p>At its adult size, my ideal dog would be (check Small (5-25lbs) Medium (25-50lbs) Large (50-80lbs) Extra large (80+lbs) all that apply) No preference</p><p>Gender preference: Male Female No preference</p><p>Spay/neuter preference: Before adoption After adoption Prefer not to be fixed</p><p>Reasons for adopting a dog (check all that Breeding Companion for self Companion for another animal Child’s pet apply) Hunting Gift for someone outside the immediate family </p><p>Guard dog for business Watch dog for home</p><p>Energy level preference: Low Medium High</p><p>Please check what is necessary to you in a dog Already housetrained Already knows basic obedience you will adopt:</p><p>Version 1.0</p><p>Section 2: About My Home</p><p>Doesn’t pull on leash Can be left in house unattended </p><p>Can be walked off leash Doesn’t jump up Doesn’t chew </p><p>Rarely barks Doesn’t dig Low-shedding Doesn’t wander </p><p>Likes to fetch/play Good watch dog Good with strangers </p><p>Will jog or run with me Gentle with young children </p><p>Likes other dogs Good with cats </p><p>Good with livestock other </p><p>Are you planning on taking your dog to Yes No obedience class?</p><p>Are you prepared to spend $300-$500 a year on Yes No basic expenses? (food, medical)</p><p>Where will your dog be kept? primarily indoors indoors and outdoors outdoors only </p><p>How many hours will your dog be left along 0-4hrs 5-9hrs 10+hrs each day? Where will your dog be left alone? Where will your dog sleep at night? </p><p>Where will your dog be exercised? fenced yard invisible fence outside kennel cable/runner stationary tie-out unfenced acreage will leash walk dog If fenced yard, what kind? </p><p>Under what circumstances would you give up bites/aggressive aggressive with other pets wanders this pet? difficult to housetrain chews/destructive when left alone </p><p> requires too much exercise moving out of state </p><p> moving to “no pets allowed” housing medical expenses/dog ill </p><p> other </p><p>Have you ever surrendered or returned a dog? Yes No If so, please explain: Please supply the name, address, and telephone Name: Address: Phone: number of two personal references (non- relatives) Name: Address: Phone: I certify that the information given is true and correct, and I hereby authorize the above listed veterinarian(s) to supply information in regard to my pets to Animal Connections. I also give my permission to Animal Connections to contact the above listed landlord and references. Signature: Date: </p><p>Version 1.0 </p>