Please complete this survey in it entirety if you are interested in adopting a dog from the Babinski Foundation.

It is the policy of the Babinski Foundation to make certain that each person who adopts a dog is aware of the responsibilities of pet guardianship, and is capable of and willing to accept those responsibilities morally, physically and financially. Not every person who desires to adopt a dog should do so. By completing this questionnaire, you will aid us in determining if you and your family are indeed ready for pet guardianship, and if the dog of your interest would suit you and your lifestyle. Should you agree that adopting a pet is a commitment throughout the lifetime of your companion animal, please fill out this questionnaire.

Name *
Phone *
Address *
Are you a student? *
Type of Home: *
Do you rent or own? *
If you are renting we need a signed letter on letterhead from your landlord.
Did you check with your landlord and/or with your home insurance company? *
Landlord's Name
Landlord's Name
Landlord's Phone Number
Landlord's Phone Number
Do you anticipate moving in the next two years? *
Size of dog (when fully grown) you are looking for: *
Check all that apply
Gender of dog you are looking for: *
Age of dog you are looking for: *
Please check all that apply
Is your yard fenced in? *
If yes to previous question, what is the fence made of?
What are some of the features of your fence?
Check all that apply
Where will your dog have access to? *
Check all that apply
Where will the pet stay when home alone? *
Check all that apply
Would you be able to tolerate potty accidents in your home? *
What traits are you looking for from your new dog? *
Check all that apply
What traits would you not tolerate from your new dog? *
What role(s) would you like your new dog to play in your residence? *
Do you have any other animals in your residence? *
Have you owned a dog in the past? *
Do you currently have a veterinarian? *
If yes please list their name, clinic, and phone number
Veterinarian's Name
Veterinarian's Name
Veterinarian's Phone Number
Veterinarian's Phone Number
You certify the information that you provided within this survey is true and correct. You give permission to the Babinski Foundation to contact your veterinarian, landlord. or any other persons listed to verify your disclosed information within this survey.