All potential adopters must fill out the following questionnaire.  Print the questionnaire and upon completion either fax it to our office at 506-684-3875, mail it to Restigouche County SPCA, 165 Baybreeze Drive, Dalhousie, New Brunswick E8C 1E4 or e-mail the information to restspca@nb.aibn.com. 

Thank you!

Adoption Questionnaire

General Information

     Name:_______________________________________________________   Date:  _____________________

     Address:_______________________________________________________  Postal Code:  ______________

     Home Phone:  _________________  Work Phone:  ___________________  Cell Phone:  _________________

     ID (to be filled out at the shelter):____________________________________________________________

     Are you  18 or over?  Y__ N __     Are you a student?  Y __  N __

     Please list 2 references with daytime phone numbers  (No family members)

     1.__________________________________________Telephone:_______________Relationship__________

     2.__________________________________________Telephone:_______________Relationship__________

Questionnaire

     1.  What animal are you interested in?________________________________________________________

         (Please keep in mind that we cannot guarantee any particular animal until the adoption is approved!)

     2.  Why do you want the animal?  Check any or all that apply!

            Companion__  Farm/Work Dog __ Hunting Dog __  Barn (cat) __ Agility/Fly Ball __  Mouser (Cat)__

            Guard dog __   Breeding (dog/cat) __  Other (Please explain): _______________________________

     3.  Is the animal for you?  Y__ N__.  If no, who is s/he for?_____________________________________

     4.  Are you prepared to care for this animal for the remainder of its natural life (10-15 years)?  Y__ N __

     5.  What breed/size of cat/dog are you most interested in?                                                                                                  

             Breed:  ______________________________    Size:  Small ___   Medium __  Large __ Xtra-Large__

     6.  Do you own or rent your home?  Own __   Rent __

     7.  If you are currently renting, the following information is required:

          Landlord's Name: ________________________________________  Phone Number:  ______________

     8.  Please indicate the number of household members:  Adults:  ______   Children:  _____

     9.  Have you ever owned an animal before?  Y__ N __

    10.  How many animals have you had in the last 5 years?  ____

    11.  If they are no longer with you, where are they now?  ________________________________________

            ___________________________________________________________________________________

    12.  Please complete the following information about any animals you have now:

             __Name of Pet______Cat/Dog/Other___Breed________Gender_M/F__Age__Altered__From__

               Example:  Poochy              Dog                  Golden Lab  ___   __         M              5         Yes   __  SPCA

            __________________________________________________________________________________________________

         __________________________________________________________________________________________________

         __________________________________________________________________________________________________

         __________________________________________________________________________________________________

         *If you require more space, please continue on the back of the page.

            If any of the above animals are not altered (spayed/neutered) please explain why:  ________________

            ____________________________________________________________________________________

            ____________________________________________________________________________________

    13.  Where will your animal reside:

            Daytime:  Indoors only  __  Outdoors only __  Both __

            Nighttime:  Indoors only  __  Outdoors only  __  Both  __

            If outside, is the animal contained?  Y __  N __  If yes, how?  Cat cage  __  Leash  __  Kennel  __  Chain __    

                                                                                                                               Fenced Yard  __

           Where will you keep your animal when you are not at home?   Who will look after your animal when you are 

            on vacation?___________________________________________________________________________

            _____________________________________________________________________________________

    14.  Name of veterinarian who has treated/will treat your animals:  __________________________________

    15.  May we call your veterinarian for  reference?  Y __  N __    If yes please provide the telephone number:

                                                                                                                            ____________________________________

    16.  Do you agree to have this animal spayed/neutered?  Y __  N __ 

            If not, why not?  _______________________________________________________________________

    17.  What traits would you find unacceptable?  Check all that apply!

             Not litter trained __  Shedding  __  Jumping up on people  __  Not housebroken  __  Barking  __ 

             Chasing Cars/bikes/people  __  Destructive  __  Not good with Children  __  Scratching furniture  __ 

             Digging  __  Jumping on counters/tables  __  Escapes/Runs away  __  Other:  ____________________