Name: _________ Partners Name____________________________________
Address: __________________________ Apt # ______________________
City: ___________________ Postal: _______
Email: ___________________________________________
Home phone: __________ Cell phone: ________________
Work Phone: _______________________________ Extension: ______________________________
Thank you for visiting the Humane Society of Kitchener Waterloo & Stratford Perth
and choosing to save a life! Please help us find a great canine match for you by
filing out this adoption survey. We are excited to help you pick your new family
member!
Dog Adoption Survey
Adopter Information:
Animal Information: (Animal ID Number can be found on the animals profile page on our website)
Animal Name:______________________________ Breed:________________________________
Animal ID #_________________________________________
1. What best describes your dog experience?
Ive never had a dog I had a dog 1+ years ago I had a dog within the last year I currently have a dog
2. I would best describe my household as:
A place with constant activity and noise Sometimes noisy/quiet Quiet and calm most of the time
3.My dog must get along with: (Check all that apply)
4. When I am not at home, my dog will be:
In the garage Outside or in the yard In a crate in the house Confined to one room Loose in house
5. When I am at home, my dog will be:
In the garage Outside or in the yard In a crate in the house Confined to one room Loose in house
More on reverse:
The Humane Society of Kitchener Waterloo & Straord Perth (HSKWSP)
For more informaon on our adopon process during Covid-19, please visit us at kwsphumane.ca
Cats Dogs (List breed below) Kids (List ages below) Other (List below)
___________________________ _____________________ _________________
6. I want a dog who: (Check one per box)
Dog Adoption Survey (Cont)
Interacts with houseguests:
All the time
Sometimes
Not Important
Can be alone:
More than 9 hours per day
□ 4-8 hours per day
Less than 4 hours per day
Likes to be by my side:
All the time
Some of the time
Not Important
Enjoys being held:
All the time
Some of the time
Not important
Enjoys being with children:
All the time
Some of the time
Not important
Is playful and active:
All of the time
Some of the time
Not important
Is vocal or talkative:
All of the time
Some of the time
Not important
Can adjust to new situations
All of the time
Some of the time
Not important
Has no training
Has had some basic training
Had had a lot of training
Has special needs (behaviour/
medical needs)
7. The personality I am looking for, in a dog is: ___________________________________________
8. My outings include: (Check one per box)
Travel more than 2
hours away:
Once a year
More than once a year
Not very often
Never
Hiking:
Once a year
More than once a year
Not very often
Never
Camping:
Once a year
More than once a year
Not very often
Never
My dog will be alone
for _______ hours
per day
8. I have training experience with: (Check all that apply)
Puppies:
Socialization classes
Obedience
Housetraining
None
Adults:
Socialization classes
Obedience
Housetraining
None
Other:
Resource guarding
Loose leash walking
Undesirable behaviours with other
animals
I acknowledge that:
I am financially able to provide veterinary care, proper nutrition and any training this dog may need
I have the time to provide training and enrichment for this dog
Applicants Signature Date
HSKWSP Staff/Vol Signature Date
Please email completed Adopon Survey and Adopon Agreement to the following email address: For animals available at our Straord
locaon: Animal-care@kwsphumane.ca. For animals available at our Kitchener locaon: Animalcare@kwsphumane.ca
Please note that we are unable to accept blank applicaons at this me
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