This form will be used by Jindo Rescue to help match potential homes with available rescue Jindos. While we welcome questionnaires from everyone, we cannot guarantee that we will be able to personally handle each prospective adopter.
PLEASE NOTE: Your questionnaire will be shared publicly with other rescuers. If you do not want your information shared in this way, DO NOT fill out this questionnaire!
Section 1: Personal Information
Name: Age: Street address: City: State: Zip: Please list the nearest big city: Phone (home): Phone (work): E-mail:
Employer Name: Position Held: How long with Employer: Hours of Work:
Spouse Occupation & Hours of Work (if applicable):
Section 2: Breed Familiarity
1. Why do you want a Jindo
2. Have you ever owned a Jindo before? No Yes 3. What qualities do you like in Jindos?
4. What qualities do you dislike in Jindos?
5. What other breeds do you like?
Section 3: Home Life
1. Who is this Jindo for?
2. Where do you live? home apartment/townhouse
3. Do you rent or own? rent own If you rent, does your landlord allow dogs? NoYes Landlord's name and phone number
4. Does your living situation have any rules regarding size or number of pets allowed? NoYes
5. How long have you lived at present home?
6. Do you have plans to move? NoYes If you move at some point in the future what will you do with your dog?
7. Do you have a fenced yard? No Yes, height type (wood, block, etc.)
8. The dog will stay indoorsmostly indoorsindoors/outdoorsmostly outdoorsoutdoors when I am away from home.
9. How long will the dog be alone?
10. Where will the dog sleep?
11. Do you have any children? No Yes In the future (maybe)
12. Please list the names and ages of all of the members of your household:
13. Do you have other dogs? No Yes
Please list a name/breed/gender/age for each:
14. If you have had dogs in the past, what happened to them?
15. How does your dog get along with other dogs?
16. Have you ever had to give up a dog or other pet? No Yes Please elaborate.
17. Do you have any cats? No Yes
18. Do you have any other pets? NoYes
Please list:
20. Please provide a name/telephone number for a current/past vet reference.(If you don't have a vet yet, please simply state that).
21. Would you object to a rescue volunteer visiting your home by appointment? No Yes
22. How did you hear about Jindo rescue or this particular dog?
Gender: male onlyprefer maleeitherprefer femalefemale only
Age (please select all that you might consider, and remember there are very few puppies in rescue): puppy (under 1 year) young adult (1-3 years) adult (4-7 years) senior (8 years or older)
Color (please select all that you might consider): yellow/red white/cream other
Activity level: couch potatooccasional walksdaily walksrunning/hikingnon-stop exercise!
Would you be willing to adopt an out-of-state Jindo before meeting him/her in person? No Yes
Would you be willing travel to another state to pick up a Jindo? No Yes How far would you travel to pick up a Jindo?
Additional information/comments:
Format created by: Peter
Modified with permission by: Ann