San Diego Humane Society and SPCA: Survey - Pre-Adoption Questionnaire

1.

Question - Not Required - Please select the type of animal you are interested in adopting.

2.

Please enter your personal contact information.

*

Name:

First Required	Middle Required	Last Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

Yes, I would like to receive e-mail from San Diego Humane Society and SPCA

Email Format:

Yes, I would like to receive postal mail from San Diego Humane Society and SPCA

*3.

Question - Required - Would you like to receive updated information about upcoming SDHS programs and events, including dog classes?

*4.

Question - Required - How did you find out about the pet you are interested in (or the San Diego Humane Society and SPCA if no specific pet)?

*5.

Question - Required - I want this animal for (please check all that apply)

	Myself
	Breeder
	For Child
	Family Pet
	Gift
	Companion for Pet

*6.

Question - Required - Do ALL the members of your household want a new pet?

7.

Question - Not Required - If not all members of your household want a new pet, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

*8.

Question - Required - Are you over 18?

*9.

Question - Required - How many adults are in your household?

*10.

Question - Required - How many children are in your household?

11.

Question - Not Required - If there are children in your household, what are their age(s)?

*12.

Question - Required - Type of home

*13.

Question - Required - Do you own your own home?

14.

Question - Not Required - If yes, how long have you owned your own home?

15.

Question - Not Required - If you rent, please provide your landlord's contact information below (your landlord will be contacted.)

(Maximum response 255 chars, approx. 5 rows of text)

16.

Question - Not Required - Please list current pets residing at your home (include roommates' pets also). Please include pets' breed, name, age, sex, spay/neuter status, # of years owned, and if they live indoors or outdoors.

(Maximum response 255 chars, approx. 5 rows of text)

17.

Question - Not Required - Do you already have a veterinarian?

18.

Question - Not Required - If you answered yes, please provide your veterinarian's name or practice name and phone number.

(Maximum response 255 chars, approx. 5 rows of text)

*19.

Question - Required - Have you relinquished or given away any pets before?

20.

Question - Not Required - If yes, please explain the circumstances involving giving up your pet, i.e. to whom, why, and when.

(Maximum response 255 chars, approx. 5 rows of text)

*21.

Question - Required - Where will your new pet be kept when you are home?

*22.

Question - Required - Where will your new pet be kept when you are NOT at home?

23.

Question - Not Required - If kept outdoors, please explain how your pet would be confined (examples might include zip line, fence, etc.)

24.

Question - Not Required - Length of time outdoors:

25.

Question - Not Required - Type of shelter provided:

26.

Question - Not Required - Type of shade provided:

27.

Question - Not Required - In a 24-hour day, how long would the pet be left alone at a given time?

*28.

Question - Required - The adoption of a lifelong animal friend should not be impulsive, but rather a carefully thought out decision, which will ensure a loving, lasting relationship. Remembering that you are applying for a lifetime companion, are you willing to make the investment in both time and finances (up to $1,000 annually) to care for and properly manage your new pet?

*29.

Question - Required - Would you be willing to allow a representative to make a home visit at a mutually agreed upon time?