Seniors for Seniors Adoption Questionnaire

IMPORTANT: This questionnaire applies only to senior applicants interested in participating in our Seniors for Seniors Adoption Program. If you are under 62 years old, please fill out our standard Adoption Questionnaire instead.

Please answer the following questions so that we can make a great match for you and your new animal companion. There are no wrong answers! Contact us if you have problems or questions in filling out this questionnaire.

General Information

  If you are under 62 years old, please STOP and fill out our standard Adoption Questionnaire instead.
Are you a veteran?    
Are you filling out this questionnaire yourself?    

If not, please provide the following information about the person who is assisting you:

What Brought You To Muttville

How did you hear about Muttville? Check all that apply.
What relationship does this person have to Muttville? Check all that apply.
Which one(s)?
What kind?

Your New Dog

Have you ever had a dog before?    
Do you prefer a:      
What size dog do you prefer:        
Is any member of your household allergic to dogs?    

Living Situation

Please provide your birthdate and the name, age, and relationship to you of each adult occupant of your home:
2nd adult occupant

3rd adult occupant

4th adult occupant

Do you have a caregiver?    

If so, please provide:

Do you:    
If you rent, do you have written permission from your landlord to have a dog?    
Do you have stairs inside or leading into your home?    
Do you have a pool?               Is it fenced?    
Will you allow us to visit your home?    

Current Animals in Your Home

Do you currently have other pets?    

Emergency Contact

Please provide an emergency contact:

Additional Comments



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