Broome County Dog Shelter Adoption Questionnaire

Thank you for your interest in adopting from the BCDS.  This questionnaire is designed to aid staff in determining if the dog of your interest is suitable for you and your lifestyle.  As the first step in our adoption process, please fill out the following:

PERSONAL INFORMATION:
Contact Information
YOUR HOME:
House Status:
Housing Type:
MAKING A PERFECT MATCH:
Which of the following best describe what you are looking for in a dog (Check all the apply):
Do you have a fenced yard?
EMPLOYMENT INFORMATION:
Are you currently: (Check all that apply)
If you become unable to care for this dog due to medical, financial, or personal reasons, what plans do you have in place for the care of the dog?
Please list ALL current and past pets:
Please include Type/Breed, Age, Sex, How long owned?, Spay/Neutered? and Kept Inside/Outside for Current Pets?
Current Pets:
more items
Please include Type/Breed, Age, Sex, How long owned?, Spay/Neutered? and Kept Inside/Outside for Current Pets?
Previous Pets:
more items
AGREEMENT:
By signing this form, I hereby certify that the information I have provided is honest to the best of my knowledge.  I give my permission for any information provided to be verified by the BCDS.  I understand this questionnaire will not be kept on file.
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