EmailMe Form - Meet Your Match - Dog Adopter Survey

EmailMeForm

Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
Home Phone *
### - ### - ####
Cell Phone
### - ### - ####
Question 1 *

Yes No

I have owned a dog before

I currently own a dog
Question 2 *

2-10 Years Ago 10 years+ Not Currently, but within the past year

The last time I had a dog was...
Question 3 *

Yes No

My dog needs to get along with other dogs
If yes, list names, ages, genders and breeds
Question 4 My dog needs to be good with (check all that apply) *

Yes No

Children over 8 years old

Children under 8 years old

Elderly People

Cats

Animals other than dogs and cats
Question 5 *

inside dog outside dog

My dog will primarily be an...
Question 7 *

4 hours or less 4-8 hours 8-10 hours 2 hours or less 12 hours

My dog needs to be able to be alone (per day)
Question 8 *

All the time Some of the time Little of the time

When I'm at home, I want my dog to be my side
Question 9 *

In the garage In a crate in the house In the yard Loose in the house Confined to one room in the house

When I'm not at home, my dog will spend his/her time...
Question 10 *

No Yes

I want a guard dog
Question 11 *

No Yes

I want my dog to hunt or herd with me
Question 12 *

Not at all Somewhat Very

I want my dog to be the type that is very enthusiastic in the way s/he shows she loves people
Question 13 *

Not at all Somewhat Very

I want my dog to be playful
Question 14 *

Very Somewhat Not at all

I want my dog to be laid back
Question 15 *

No training Some training A lot of training

I am comfortable doing some training with my dog to improve manners such as jumping, stealing food, and pulling on the leash
Question 16 *

No Yes

I (or my children) want to participate in Agility, Flyball, or Obedience with our dog
Question 17 *

No Yes

I am interested in a dog with "special needs" (medical or behavioral)
Question 18 *

It's most important to me that my dog....

What is the most important thing you want out of a dog (i.e., runs with you, sits on the couch with you, is good with kids, does not bark a lot)

	2-10 Years Ago	10 years+	Not Currently, but within the past year
The last time I had a dog was...

	Yes	No
Children over 8 years old
Children under 8 years old
Elderly People
Cats
Animals other than dogs and cats

	4 hours or less	4-8 hours	8-10 hours	2 hours or less	12 hours
My dog needs to be able to be alone (per day)

	All the time	Some of the time	Little of the time
When I'm at home, I want my dog to be my side

	In the garage	In a crate in the house	In the yard	Loose in the house	Confined to one room in the house
When I'm not at home, my dog will spend his/her time...

	Not at all	Somewhat	Very
I want my dog to be the type that is very enthusiastic in the way s/he shows she loves people

	No training	Some training	A lot of training
I am comfortable doing some training with my dog to improve manners such as jumping, stealing food, and pulling on the leash

	No	Yes
I (or my children) want to participate in Agility, Flyball, or Obedience with our dog

	No	Yes
I am interested in a dog with "special needs" (medical or behavioral)

	Yes	No
I have owned a dog before
I currently own a dog

	inside dog	outside dog
My dog will primarily be an...