Adoption Questionnaire
Full Name:
Street, City, State, Zip Code
Home (h) and Work (w) Phone #:
h
w
Name the dog are you interested in?
Or describe the type of pet you are looking for (e.g. young/adult, m./fem., sm./med./large, long-haired/short-h.)?
Do you currently own pets?  If so, what kind?
Do you have children/grandchildren? What age?
Do you own/rent?
Do you have a yard/
fence/height of fence?
Where would you keep the pet
during the day?
at nights?
What is your main reason for adopting a pet?
Is anyone in your family allergic to dogs?
Have you had a pet before?  Please list all pets previously owned:
Dog or Cat?
For how long?
Reason for surrender
Are you aware, that adopting a pet is a lifetime commitment and should not be a spur-of-the-moment decision?
Are you aware that a lot of these dogs up for adoption have been handed around (sometimes even abused)   and are therefore looking for a loving, understanding and PERMANENT home?
The dog's optimum health must be maintained through the feeding of quality dog food, adquate shelter, an annual physical with your veterinarian including updating vaccinations.

VDR reserves the right to arrange a follow up visit and to ascertain if all conditions of this adoption are being upheld. Should any term or condition of this agreement not be upheld, VDR reserves the right to terminate this agreement and to recover the dog.
If, for any reason, this adoption is not satisfactory to the adoption party, at any time during the life of the dog, he/she MUST be returned to VDR.  It may NOT be given away or sold to anyone else without the permission of VDR, nor can it be released to another shelter or pound.
The adopted pet MUST wear identification at ALL times. 
Should the adopted dog not work out, then the adopting party can try out another dog.  In any case, we do recommend to give your new pet at least one week before making a decision (which is detrimental to the animal to adjust to its new environment.)
The undersigned has read and understands all the terms of this adoption and agrees by all the terms and conditions stated above.
Signature/or Print Name
Signature/or Print Name
Ursula Shepherd, Dog Rescue (VDR)
P.O. Box 824, Carbondale, CO  81623
Ph. (970) 963-3858
www.valleydogrescue.com
In case of an adoption, please bring this questionnaire/agreement to the adoption for signature:

E-Mail Address:
List one reference (name & phone number):
How long would the dog be alone during the day?
NoYes
NoYes
OwnRent-Name&ph.# of landl.
No yardYard/fence-How high?
NoYes
YesNo
YesNo
I agree
I agree
I agree
I agree