[City of Irvine] Form 57-07: IACC Dog Adopter Survey

COMMUNITY SERVICES | Irvine Animal Care Center

DOG ADOPTER SURVEY

Thank you for your interest in adopting a new family member from our shelter. In an effort to help you find your match please provide the following information. Adopters must be 18 years or older.

First Name

Last Name

Street Address

City

State

Zip

Preferred Phone

How many adults live in your household?

How many children live in your household?

Seniors may qualify for special pricing. Are you 62 years of age or older?

Yes

Enter the dog name(s) as listed on the adopt webpage:

First Choice

Second Choice

Third Choice

TELL US ABOUT YOU

I have owned a dog before:

Yes

Currently own dog(s)

Last time I had a dog was:

2-10 years ago

10+ years

Not currently, but within the past year

My dog needs to get along with other dogs:

Yes

List names, ages, genders, and breeds:

My dog needs to be good with (check all that apply):

Children over 8 years old

Children under 8 years old

Elderly people

Cats

Animals other than dogs and cats

My dog will primarily be an:

Inside dog

Outside dog

How many hours will your dog spend outside per day?

My dog needs to be able to be alone (per day):

2 hours or less

4 hours or less

4-8 hours

8-10 hours

12 hours

When I am home, I want my dog to be by my side:

All of the time

Some of the time

Little of the time

When I am not home, my dog will spend their time:

In the garage

In a crate in the house

In the yard

Loose in the house

Confined to one room in the house

I want a guard dog:

Yes

I want my dog to be the type of dog that is very enthusiastic in the way they show they love people:

Yes

I want my dog to be playful:

Not at all

Somewhat

Very

I want my dog to be laid back:

Not at all

Somewhat

Very

I am comfortable doing some training with my dog to improve manners such as jumping, stealing food, and pulling on leash:

No training

Some training

A lot of training

I (or my children) want to participate in agility, flyball, or obedience with our dog:

Yes

I am interested in a dog with "special needs" (medical or behavioral):

Yes

It is important for me that my dog:

Thank you for your honest answers. The information you provide will help us find a pet that is suitable for you.

Meet your Match courtesy of ASPCA.

The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, all information provided on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals.