Kiko Adoption Questionnaire

Please provide as much information as you can to help ensure a great match!

If you are interested in a particular dog, what is his/her name?
How did you hear about us?
When are you ready to welcome a new dog home?
Your name Your name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary phone number Primary phone number - ### - ### ####
Secondary phone number Secondary phone number - ### - ### ####
Email address
Age and occupation
If you are under 18 years of age, are your parents aware that you are completing this questionnaire?

If you are under 18 years of age, are your parents aware that you are completing this questionnaire? Yes No
YOUR HOME AND LIFESTYLE
What type of home do you live in?

What type of home do you live in? Apartment Condo House
Are you the homeowner?

Are you the homeowner? Yes No
If you answered 'no' to the above, do you have a written lease granting permission to have a dog on the premises?

If you answered 'no' to the above, do you have a written lease granting permission to have a dog on the premises? Yes No I'm not sure Not applicable
Which of the following best describes your residential environment?

Which of the following best describes your residential environment? Urban Suburban Semi-rural Rural Agricultural
Do you have a backyard?

Do you have a backyard? Yes No
If you answered 'yes' to the above, is it a fully fenced dog-friendly backyard?

If you answered 'yes' to the above, is it a fully fenced dog-friendly backyard? Yes No Not applicable Other description of the backyard or outdoor space:
How many adults are living in the home and what are their ages?
How many children are living in the home and what are their ages?
If no children, are you considering children in the foreseeable future?

If no children, are you considering children in the foreseeable future? Yes No Not applicable
Are there children who visit the home often?

Are there children who visit the home often? No Yes, as detailed below: Yes, as detailed below:
Are any family members at home during the day?

Are any family members at home during the day? No Yes, as detailed below: Yes, as detailed below:
How many hours a day would the dog be alone at home?

How many hours a day would the dog be alone at home? 0-3 3-6 6-9 9-12
Does anyone in the home have allergies?

Does anyone in the home have allergies? No Yes, as detailed below: Yes, as detailed below:
Does anyone smoke inside the home?

Does anyone smoke inside the home? Yes No
With reference to visitors, which of the following best describes your lifestyle?

With reference to visitors, which of the following best describes your lifestyle? Frequent visitors Occasional visitors Not many visitors
How are you planning to handle the dog's exercise needs and toilet duties?
YOUR PETS
Have you ever surrendered a pet to a pound, shelter or rescue organization?

Have you ever surrendered a pet to a pound, shelter or rescue organization? No Yes, as detailed below: Yes, as detailed below:
How many dogs have you owned in the last 5 years?
Do you currently have other dogs in the home?

Do you currently have other dogs in the home? No Yes, breed(s), age(s) and gender(s) detailed below:
Where did you get your dog(s) from?
How long have you had your dog(s)?
Are your dog(s) spayed and/or neutered?

Are your dog(s) spayed and/or neutered? Yes No Not applicable
Do you currently have any cats in the home?

Do you currently have any cats in the home? No Yes, as detailed below: Yes, as detailed below:
Where did you get your cat(s) from?
How long have you had your cat(s)?
Are your cat(s) spayed and/or neutered?
Do you have any other pets in the home?

Do you have any other pets in the home? No Yes, as detailed below: Yes, as detailed below:
YOUR IDEAL DOG
What breed(s) or mix(es) are you most interested in?
Do you require a dog that is hypoallergenic?

Do you require a dog that is hypoallergenic? No Yes, as explained below: Yes, as explained below:
What gender of dog are you most interested in?

What gender of dog are you most interested in? Male Female Doesn't matter
What age group of dog are you most interested in?

What age group of dog are you most interested in? Puppy 1-3 years 3-6 years 6-10 years Senior
What size of dog are you most interested in?

What size of dog are you most interested in? Small (0-25 lbs / 0-11 kg) Medium (26-60 lbs / 11-27 kg) Large (61-100 lbs / 27-45 kg) Extra large (101+ lbs / 45+ kg)
What is your preferred energy level in a dog?

What is your preferred energy level in a dog? Low Medium High
What kind of diet and brand of food are you planning to feed your new dog?
Where will your new dog spend most of the day?

Where will your new dog spend most of the day? Loose indoors Crated indoors In a room indoors Loose outside Tied outside In a pen outside Outside in a fenced backyard
Where will your new dog spend most of the night?

Where will your new dog spend most of the night? Loose indoors Crated indoors In a room indoors Loose outside Tied outside In a pen outside Outside in a fenced backyard
When your family is away from home overnight or on vacation, what will you do with your dog?
If your new puppy or dog demonstrates behaviour issues that you find challenging, would you be willing to seek assistance from a reputable and qualified professional recommended by Kiko?

If your new puppy or dog demonstrates behaviour issues that you find challenging, would you be willing to seek assistance from a reputable and qualified professional recommended by Kiko? Yes No Maybe
Are you prepared to work with a dog that may require some level of toilet training?

Are you prepared to work with a dog that may require some level of toilet training? Yes No Maybe
Under what circumstances would you give up your dog?
How will you help your new dog adjust to his or her new environment?
Do you consent to a home visit prior to adoption?

Do you consent to a home visit prior to adoption? Yes No
Are you aware that Kiko dogs have been examined by a veterinarian, vaccinated, sterilized, and microchipped, and require an adoption fee of $650 for adult dogs, $725 for puppies under a year old and an adoption contract?

Are you aware that Kiko dogs have been examined by a veterinarian, vaccinated, sterilized, and microchipped, and require an adoption fee of $650 for adult dogs, $725 for puppies under a year old and an adoption contract? Yes No
Which veterinary clinic will be taking care of your new dog, and do you currently have a file with them?
Is there anything else you'd like us to know about you?
Are you currently in contact with other rescue organizations in your search for a dog to adopt?

Are you currently in contact with other rescue organizations in your search for a dog to adopt? No Yes, as detailed below: Yes, as detailed below:

Kiko Adoption Questionnaire

Kiko Adoption Questionnaire

YOUR HOME AND LIFESTYLE

YOUR PETS

YOUR IDEAL DOG