- How many? Ages?
number of people in household (roommates, etc):
list members of household and relationship to you (roommates,
husband, mother etc):
you Own or Rent your home?
renting, does lease allow dogs?
long have you resided at current location?
of employment (adults only) and how long employed there?
plans to transfer to another location or change of employment?
many hours a day will your dog be left alone?
0 - 5 Hours
6 - 8 Hours
9 - 12 Hours
12 + Hours
will your dog be kept while you are not home?
Free Roam of House
describe when/where you will walk/exercise the dog on leash?
all places where dog will be allowed to have off leash
much time do you realistically have each day to exercise or
play with your dog
will care for your dog while you are on vacation/travel
many weeks a year are you away from home on business or
0 - 2 Weeks
3 - 4 Weeks
5 - 6 Weeks
7 + Weeks
will you encourage and reinforce appropriate behavior?
you have had a dog in the past, did you ever have to deal with
any behavioral issues (housebreaking, chewing, separation
anxiety)? if so, please list the issue's) you have
will you prevent/manage inappropriate behavior?
do you foresee as normal dog problems?
your dog ever be left outside unattended when you are not
When Weather is Nice
will you do with your dog if you have to move?
Find a New Home
for the Dog
Take Dog on Move
Take to Local
Mutts Matter Rescue
will be primary caretaker of the dog?
size dog will appeal to you most when it's fully grown?
Tiny (0 - 8 lbs)
Small (10 - 20 lbs)
Medium (25 - 50 lbs)
Large (50 + lbs)
anyone in your household have allergies to animals/dander? If
yes, please explain
will your dog sleep?
type of monthly heartworm and flea preventative will you
provide each month?
check all that apply... I would considering giving my dog back
my work schedule changes dramatically and I no longer have
sufficient time for the dog
I have children in the future and no longer have sufficient
time for the dog because of the demands of parenting
other changed circumstances prohibit me from having sufficient
time with the dog
someone in the household becomes allergic
I become ill and can no longer take care of the dog
I lose my job
i divorce or separate from my spouse/partner
my new significant other does not like the dog
dogs sheds excessively
the dog is not housebroken
the dog is or becomes aggressive
other, please explain
you ever owned a dog/cat/other pet? (do not include family
pets from childhood)
yes, please list past and current pets
your pet spayed or neutered?
did you get pet from?
list your Vet Hospital, Dr's Name and Phone #
list an additional reference (name and phone #) of someone
that is not related to you that we may call.
you ever had to give up a pet for any reason? If yes, what
happened to the pet?
you permit a home visit by a MMR representative?
use the space below for any additional comments you would like
to make to Mutts Matter: