Adoption Screener's Worksheet

Note: This is a sample worksheet that you can adapt to fit your particular situation.

Adoption Screener’s Worksheet

Date call received________________Date of interview ____________________

Name and address ________________________________________________________________

Phone numbers: Day________________Evening ________________________

Record the prospective adopter’s answers to these questions:

How did you hear about the pet? ________________________________________________________

What type of animal are you looking for? _________________________________________________

Who is the animal for? ________________________________________________________________

Who will be the primary caregiver? ______________________________________________________

Do you have other pets at home? ___ Yes ___ No

If yes: Please tell me about them. ________________________________________________________________

________________________________________________________________

If no, ask: Have you had pets before? _____ If yes: What happened to them?

________________________________________________________________\

Do you have children? _____ If yes: How old are they? _____________________________________

Do all members of the household know about and want a new animal?

___ Yes ___ No

If no, please explain: ________________________________________________________________

Do you live in a house, a mobile home, or an apartment? _____________________________________

Do you own your home or are you renting? ________________________________________________

If renting, does your lease allow pets? ___ Yes ___ No

May I call your landlord? ___ Yes ___ No Landlord’s phone _________________

Can I come to your home, to see where the animal will be living?

___ Yes ___ No

How many hours would the animal be alone during the day?

________________________________________________________________

If you’re trying to find a home for a dog:

Does your home have a yard and is it completely fenced? ___________________________________

Will the dog get regular exercise? ______________________________________________________

If you’re trying to find a home for a cat:

Will the cat be an indoor or outdoor cat? _________________________________________________

Would you consider declawing a cat? ___ Yes ___ No

After the interview, record your impressions:

Does the prospective adopter seem responsible? ____________________________________________

Flexible and compassionate? ___________________________________________________________

What is your general impression of this person? (Go with your gut feeling.)

________________________________________________________________

Any doubts that this will be a good home? ________________________________________________________________

________________________________________________________________