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Please fill out all the information to the best of your knowledge. If you want to be considered for adoption, please call the Quincy Humane Society after submitting the form. (217) 223-8786
Dog Adoption Survey / Application
Name:
Address:
City, State, Zip:
Phone:
Email Address:
Currently I...
Work
Attend school
Am retired
Am unemployed
Other
I live in a...
House
Apartment
Condo
Dorm
With Parents
Do you own or rent?
Own
Rent
Landlord's Name:
Landlord's Phone:
1. I have owned a dog before:
Yes
No
2. The last time I had a dog was...
Currently have dog(s)
Less than 1 year
2-10 years
10 years
3. My dog needs to get along with other dogs.
Yes
No
4. My dog needs to be good with (Ctrl click to select all that apply):
Children under 8 years old
Children over 8 years old
Elderly people
Cats
Animals other than dogs and cats
None of the above
5. My dog will primarily be an...
Inside dog
Outside dog
6. How many hours will your dog spend outside per day?
7. My dog needs to be able to be alone (per day)...
2 hours or less
4 hours or less
4-8 hours
8-10 hours
12 hours
8. When I'm home, I want my dog to be by my side...
All of the time
Some of the time
Little of the time
9. When I'm not at home, my dog will be kept...
Loose in the house
Confined to one room in the house
In a crate in the house
In the garage
In the yard
Other
10. I want a guard dog.
Yes
No
11. I want my dog to be energetic / playful.
Not at all
Somewhat
Very
12. I am willing and comfortable doing obedience training with my dog.
No training
Some training
A lot of training
13. I am interested in a dog with special needs (medical or behavioral):
Yes
No
List the types and number of pets you have had or still have for the past five years (Example: 2 cats, 1 dachshund, and 2 guinea pigs)
Were these pets spayed or neutered (fixed)?
Yes
No
Not all
Do you still have these animals?
Yes
No
Not all
Please describe what happened to the animals you no longer own (if any):
Where do you keep your pets?
Primarily inside
Primarily outside
Inside / Outside
Other
Veterinarian Clinic (Example: Western Illinois Vet Clinic in Quincy, IL):
Name of the dog you are interested in adopting:
