survey adoption form test – Danbury Animal Welfare Society

Date (required)

First and Last Name (required)

Street Address (required)

City (required)

State (required)

Zip (required)

Phone (required)

Your Email (required)

Employer

Work phone

Driver’s License No (required)

Issuing State (required)

Are you applying to adopt a:
DogPuppyCatKitten

If cat/kitten, are you planning to declaw? Why or why not?

Is this your first experience with a pet?
YesNo
How many dogs/cats have you owned in the past?

Dogs (required)

Cats (required)

If you have a specific animal in mind, what is the animal’s name?

Have you ever adopted an animal from DAWS?
YesNo
If so, when?

Have you previously submitted an adoption application to DAWS?
YesNo
If so, when?

Why do you want to adopt a pet? Check all that apply. (required)
CompanionWatchdogBarn Cat/MouserBreedingHuntingFamily PetChild’s PetCompanion for Another PetGuard Dog for BusinessOther

Do you currently or have you had any pets in the last 5 years? Please select below (required)

Please enter information for any pets you have owned in the past 5 years, including current pets:

Pet 1:

Name

Breed/Species

age

Neutered/Spayed?

YesNo

Declawed?

YesNo

Alive/Deceased?

AliveDeceased

Veterinarian

Veterinarian Phone Number

Pet 2:

Name

Breed/Species

age

Neutered/Spayed?

YesNo

Declawed?

YesNo

Alive/Deceased?

AliveDeceased

Veterinarian

Veterinarian Phone Number

Pet 3:

Name

Breed/Species

age

Neutered/Spayed?

YesNo

Declawed?

YesNo

Alive/Deceased?

AliveDeceased

Veterinarian

Veterinarian Phone Number

Pet 4:

Name

Breed/Species

age

Neutered/Spayed?

YesNo

Declawed?

YesNo

Alive/Deceased?

AliveDeceased

Veterinarian

Veterinarian Phone Number

Pet 5:

Name

Breed/Species

age

Neutered/Spayed?

YesNo

Declawed?

YesNo

Alive/Deceased?

AliveDeceased

Veterinarian

Veterinarian Phone Number

Where do you currently live?
HouseApartmentMobile HomeCondominiumTownhouse

Do you own or rent? (required)

Landlord Name (required)

Landlord Number (required)

If you rent, does your lease/landlord allow pets? YesNo

How many hours a day will the pet be alone? (required)

Our pet will live (required):
Indoors OnlyIndoors/OutdoorsPrimarily Outdoors

Do you have a fenced in yard?
YesNo

Household Information:

Number of Adults (required):

Do you have children (required)

Number of Children: (required)

Ages of Children:

Do all the adults in the household know that you plan to adopt a pet? (required) YesNo

Please check any topics that you would like to discuss with us:
House TrainingIndoors vs. OutdoorsSeparation AnxietyChewingFeedingCrate TrainingExercise RequirementsPets and ChildrenObedience TrainingEscapingDisaster PreparationHeartwormsVaccinationsIntro. to Other AnimalsLeash/Licensing lawsMicrochipping

Meet Your Match cat survey

I would consider my household to be like
A libraryMiddle of the roadA carnival

I am comfortable with a cat that likes to play “chase my ankles” and similar games
NoSomewhatYes

I want my cat to interact with guests that come to my house
Little of the timeSome of the timeAll of the time

How do you feel about a boisterous cat that gets into everything?
Love them but rather not to live with themDepends on the situationFine by me

My cat needs to be able to adjust to new situations quickly
Not importantSomewhatYes

I want my cat to love being with children in my home
It’s not important whether my cat loves being with childrenSome of the timeMost of the timeChildren do not often come to my house

My cat needs to be able to be alone
More than 9 hours per day4 to 8 hours per dayLess than 4 hours per day

When I am at home, I want my cat to be by my side or in my lap
Little of the timeSome of the timeAll of the time

I want my cat to enjoy being held
Little of the timeSome of the timeMost of the time

I need my cat to get along with
dogscatsBirdsOther

My cat will be
InsideInside and OutsideOutside

I have lived with cats before
YesNo
I prefer my cat to be talkative
YesNoIt’s not important if my cat is talkative
I want my cat to play with toys
Little of the timeSometimesOften
I want my cat to be active
Not very active at allSomewhatYes, very

It's most important to me that my cat ...

Meet Your Match dog survey

My dog needs to be able to be alone (per day)
2 hours or less2-4 hours4-8 hours8-10 hours12 hours

When I'm at home, I want my dog to be by my side
all of the timesome of the timelittle of the time

When I'm not at home, my dog will spend her time
in the garagein a crate in the housein the yardloose in the houseconfined to one room in the house

I want a guard dog
yesno

I want my dog to hunt or herd with me
yesno

I want my dog to be the type that is very enthusiastic in the way she shows she loves people
not at allsomewhatvery

I want my dog to be playful
not at allsomewhatvery

I want my dog to be laid back
not at allsomewhatvery

I am comfortable doing some training with my dog to improve manners such as jumping, stealing food, and pulling on the leash
no trainingsome traininga lot of training

I (or my children) want to participate in agility, flyball or obedience with our dog.
yesno

I am interested in a dog with "special needs" (medical or behavioral)
yesno

It's most important to me that my dog ...

References:

Please Enter 3 references below

Reference 1:

Reference Name

Phone Number

Relationship to Applicant

Reference 2:

Reference Name

Phone Number

Relationship to Applicant

Reference 3:

Reference Name

Phone Number

Relationship to Applicant

I understand that DAWS reserves the right to approve or deny any adoption application, and the completion of this application does not guarantee an adoption of a DAWS animal. I affirm that I have answered all questions truthfully and to the best of my knowledge. I also represent that I am willing and able to accept full and immediate responsibility for the ownership and care of the animal(s) I am applying to adopt.

I Confirm (*Required for application submission)