CHELSEA BAILEY BUTTE-SILVER BOW ANIMAL SHELTER

 

 

PEOPLE AND DOGS PROFILE

                                                                                                                                                                                   

                               

Thank you for filling out this profile.  The information you provide

will help us help you find the best match for you and your family.

 

“A dog is the only thing on earth that loves you more than it loves itself”

                                                                                                 ________Josh Billings

 

Date _____________________                                                                         Employee __________________

 

 

YOU AND YOUR FAMILY

 

Name _____________________ Driver’s License/I.D# ______________________ Are you 18 years or older?

 

Name ______________________________                                                                         Yes      No

 

Street address _________________________ City __________________ State _____________ Zip _______

 

Home phone ____________________ Place of work ____________________ Work phone ______________

 

Type of housing (check all that apply):   Own  Rent  Live with parents  Military

                                                                 House  Condo  Apartment  Mobile

 

Length of time at current address: Months _____________ Years _____________

Landlord name ____________________________________________ Phone __________________________

 

Name of friend not living with you ____________________________ Phone __________________________

 

Veterinarian ______________________________________________ Phone __________________________

 

Adults living in the household:  Men, how many? _____________  Women, how many? ____________

 

Children living in the house hold:  Boys, how many? __________ Ages: ____________________________

                                                        Girls, how many? __________ Ages: ____________________________

 

Is there anyone in the household allergic to pets?   Yes  No Explain _____________________________

 

Is there anyone in the household nervous or unsure of dogs?   Yes  No Explain ____________________

 

Do you have children in the neighborhood that visit?   Yes  No Ages: ___________________________

 

PET HISTORY - EXPERIENCE

 

Current Pets

        Type                      Name                Age          Sex           Spayed/Neutered       Where is the pet kept?

                                                                                                                                                   

1. ______________  ______________  ________  _______         Yes  No           In  Out  Both   How long have you owned this pet? ______________________

 

2. ______________  ______________  ________  _______          Yes  No           In  Out  Both   How long have you owned this pet? _________________________

 

Past Pets

 

             Type                          Name               Spayed/Neutered      Where was the pet kept?   How long owned?

 

1.  _____________  __________________     Yes  No           In  Out  Both     ______________

What happened to this pet? __________________________________________________________________

 

2.  _____________  __________________     Yes  No            In  Out  Both    ______________

What happened to this pet? __________________________________________________________________

 

What’s your dog experience?  First-time owner  Have had one or two  Knowledgeable & Experienced

 

Why do you want to adopt this dog?  __________________________________________________________

 

What will you do with the dog when you leave town?  ____________________________________________

 

What will you do with the dog when you move?  _________________________________________________

 

If traveling with me, the dog would be:  Inside the car  Back of pick-up truck  Crate

                                                                 None, would stay home

 

If the dog becomes sick or injured will you take it to the vet immediately?   Yes  No   Depends

 

When I relate to dogs I tend to be:  Strict, demanding, a real leader (dog sits for treat)

                                                         Lenient, (dog gets treat because they’re cute)

                                                         Demanding or lenient, depending on the dog and situation

Will you be crate-training the dog?   Yes  No

 

If you returned home to find that the dog had chewed your favorite shoes or urinated on the floor what would you do? _________________________________________________________________________________

 

If the dog needs professional training, are you willing and financially able to enroll the dog in a group class or with a private in-home trainer?   Yes  No

 

Who will be the primary care-taker of this dog? __________________________________________________

 

YOUR HOUSEHOLD

 

Time away from the animal:  Home all day  Out part-time  Away 7 – 10 hours daily

 

Where will the dog be kept during the day? _______________________ At night: _____________________

Where will the dog be kept when you are not at home? ___________________________________________

 

Household activity level:  Quiet  Active  Very active

 

Availability to exercise the dog:  Minimal exercise during week/lots of exercise on weekends

                                                     Would go running daily with me

                                                     Long morning and evening walks

                                                     Three 15-minute walks a day

 

Do you have a fenced yard?   Yes  No  (please be honest, if you don’t have a fenced yard it’s o.k., certain               

                                                                         dogs definitely need a fenced yard.)

If yes, type of fencing ______________ How high?______________ Is it secure? ______________________

Do you have a kennel or run?  Yes  No  Is it covered?  Yes  No 

Do you plan on having a tie-out or cable run for the dog?  Yes  No  If yes, type ____________________

 

 

HOPES AND EXPECTATIONS

 

Breed Type/Mix ________________________________  Color/s _________________________________

 

Size:   0-10 lbs  10-30 lbs.  30-55 lbs  55-85 lbs.  85-100 lbs.  100 & Up

 

Age:   8-16 weeks  4-12 months  1-3 years  3-7 years  8 & Up (Seasoned veterans, like Albert)

 

Coat:   Short  Medium  Long  No preference

 

Sex:  Male Female  No preference

 

Temperament and Activity level (check all that apply)

   Zippy, high energy, puppy like                              Mellow, easy going

   A lap dog                                                                Very affectionate

   A total kissy face                                                    Responsive

   Independent                                                            Vocal, talkative

   Quiet                                                                       Likes kids

   Protective                                                                Special needs

   Other: ____________________                             Likes other animals, Type ____________________

 

 Training:   Has none  Is housebroken  Has some obedience training  Is fully trained

 

I prefer a dog whose energy level is:   High  Medium  Low  Couch potato

 

I prefer a dog that:   Will enjoy with me on leash        Will enjoy with me on or off leash

                                 Will run, jog or hike with me      Will exercise itself in our yard

                                 Requires only enough exercise to do its “business” outside

 

Reason for wanting this dog: (check all that apply)   Gift  Watchdog  Companion

                                                                                    Companion for other pet   Worker

                                                                                    Hunter  Other:   ____________________

 

What personality traits are you looking for in your dog? ___________________________________________

________________________________________________________________________________________

 

Dog habits I just can’t tolerate are: ____________________________________________________________

________________________________________________________________________________________

 

I would like more information about: __________________________________________________________

                                                                                          Example: dog to dog intro, housetraining, crate-training, identification, vaccinations etc.

 

It sometimes takes a dog longer to adjust to a home that already has resident kids, dogs and cats.  In some cases the new dog and other animals may never bond, only tolerate each other.  How will you handle this? _______________________________________________________________________________________

 

RELEASE AND AGREEMENT

 

I certify that the information I have given is true, and I authorize the CBBSB Animal Shelter to contact veterinarians, landlords and references to investigate all statements in this application, and to do follow-up property checks.

 

Signature _________________________________________________ Date __________________________

 

STAFF USE ONLY

 

Pending Adoption:  Yes, Date ___________