DALMATIAN RESCUE OF SOUTHERN CALIFORNIA INC.

ADOPTION QUESTIONNAIRE

We appreciate your interest in our dogs. To enable us to get to know you better, please
complete the following questions. Please be as thorough and explanatory as possible.

Date: ___________________________
Name (include spouse or partner): ___________________________________________
Address (street, city, state and zip code): ______________________________________
_______________________________________________________________________
Home phone ____________Work phone _____________Cell Phone________________
Email address or addresses: _________________________________________________
Best time to be contacted and preferred method of contact (phone, email, text,
mail):__________________________________________________________________

How did you hear about us? ________________________________________________

Are you a prior adopter and if so, who did you adopt from us and approximately when
was that?_______________________________________________________________

Why do you want to adopt a dalmatian or a dalmatian mix?

Do all parties ( if there is more then one adult in household ) want a Dalmatian or
dalmatian mix? ____________________________________________________

Have you ever owned a dalmatian or a dalmatian mix? Yes ___ No ____. If not, please
describe what experience you have, if any, with dalmatians and dalmatian mixes:

Have you ever adopted a dog from a dog rescue group or an animal shelter?___________

Are you inquiring about a specific dog or dogs on our website, and if so, which dog or
dogs are you interested in?

Please specify what traits or characteristics you are looking for in an adopted dog:
_____________________________________

Please indicate your level of experience (beginning, moderate or advanced) as a dog

owner, indicating the basis of your experience: __________________________________
________________________________________________________________________
Activities that you participate in that will include your dog:

Hiking __ Walking ___ Jogging ___ Agility ___ Camping ___ Dog Parks ___ Biking ___
Swimming/Boating ___ Other ___

Dalmatians and dalmatian mixes are generally high energy dogs. Please advise as to your
plans regarding exercise for the adopted dog on a daily and weekly basis.
________________________________________________________________________
________________________________________________________________________

What dogs do you currently have (breed, age, sex ):______________________________

________________________________________________________________________
________________________________________________________________________
What dogs have you owned over your lifetime? _________________________________
________________________________________________________________________
What happened to your prior dogs?___________________________________________
_______________________________________________________________________

Have you ever given up a dog you owned to a friend, shelter or rescue, or returned a dog
you adopted or purchased to a shelter, rescue or the adoptive party, and if so, please
describe the circumstances.
________________________________________________________________________

How do your current dogs get along with other dogs? ____________________________

Are your current dogs spayed or neutered , and if not, why not: _____________________
________________________________________________________________________

Have you ever trained prior dogs in obedience? ______ Are you willing to train in
obedience? ___________

Are you willing to seek expert advice from a trainer or behaviorist should issues arise
with the newly adopted dog?____________________________________________

What type of dog food do you feed your current dogs?________ Served watered or dry?
_____ How much and how often? ____________________________

What type of dog food do you plan on feeding the adopted dog?_____ To be served
watered or dry?_______________ How much and how often?________________

Do you feed your current dog table scraps or other people food, and if so, what types of
scraps and how much_____________________________________________________
Do you plan on feeding the adopted dog table scraps or other people food, and if so what
types of scraps and how much ______________________________________________

Do you own cats or other small animals (rabbits, gerbils, hamsters, chinchillas, etc.)____
What type?___________ Are they kept separate from the dogs? ____________________

Do you own horses or other livestock?____ What type?

___________________________ Are they kept separate from the dogs?
_________________________________________

Name, address and phone number of your veterinarian

________________________________________________________________________
________________________________________________________________________

Do you have a fenced yard? Front ____ Back____ Side____ Not fenced ____________

Size of yard _______________ Fence height ______ Fence type ___________________

Will the adopted dog have access to all or only part of the yard?____________________

Please describe the yard including size and ground cover to which the dog will have
access: _________________________________________________________________

What type of shade or cover is there in the part of the yard to which the dog will have
access?_______________________________________________________________

What kind of accommodations do you have for the dog in the cold and in the heat?
____________________________________________________________________

Do you have a dog door, and if so, where does it lead?_________________________

Anyone home during the day? ____Explain __________________________________

Maximum hours dog would be left alone_____________ Explain_________________
______________________________________________________________________
Where would the dog stay when you are not at home? ___________________________
Will the dog be allowed to live inside?_____________________________________
Where will the dog sleep? ______________________________________________

Do you own / have a dog crate? __________________

Do you plan on crating the dog, and if so, for what period of time?_____________

Do you maintain rat poison, snail bait or other poisons or toxins in your home, and if so,
where are they kept and would the dog have any access to this area?________________

________________________________________________________________________
What do you do with your pets when you go on vacation? ___________________
__________________________________________________________________

Ages of children in contact with dog ____________________________________

Do the children have prior experience with dogs and if so, describe experience _______
_______________________________________________________________________

Any asthma or allergies in household to dogs or cats?_____________________

How severe ? ______________________________________________________

Describe neighbors that the dog will be involved with (do they like dogs? have children?
have dogs, cats?) ___________________________________________________

Any problems currently with neighbors? _____________________

Explain _____________________________________________________________

Do you own your home? __________________

If not, do you have permission from landlord to own dogs there? ______________

Any questions about the breed or dog ownership that we may answer for you?
______________________________________________________________________

Adopted dogs need an adjustment time, are you willing to give the new dog at least a
month adjustment period after the adoption? __________________________________

What in your opinion would constitute a reason for not keeping the dog?
______________________________________________________________________
______________________________________________________________________

We are always in need of temporary homes for our rescue dogs, would you be willing to
foster a needy Dalmatian if it is compatible with your lifestyle and pets? __________
For how long ____________ until placed? __________

We will be requesting an adoption fee to cover our costs including shelter fees,
veterinarian fees, foster care expenses and kennel costs.

By signing this questionnaire you acknowledge that completion of this form does not
guarantee that we will place a dog with you. You must first pass our interview, our home
inspection and complete one of our Adoption Contracts including at least 2 post adoption
home visits for the purpose of checking on the dogs well being. We reserve the right to
terminate the adoption process at any time.

Sign here __________________date ____________________

Please return by email to dalrescue@sbcglobal.net