Phone Interview

Coordinator: *

Date: *

Applicant Information

(Please list all adults in household involved in adoption)

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address

Phone Interview Questionnaire

1. Where did they hear about MAGDRL? *

1a. Name of place or paper:

2. Have they had Danes before? If so what happened to the dane(s)? *

No

Yes Yes

2a. Have they or anyone in their household ever been in contact with MAGDRL concerning a Dane, either adoption or turn in? *

No

Yes

If yes, explain the nature of the contact.

3. What types of dogs have they owned as adults and what happened to them? *

4. Do they have animals currently? List Breed, Age, Spayed/Neutered. *

4a. Are they seen at least once a year for an annual exam? If not, why?

Yes

No No

4b. Are they up to date on all vaccinations? If not, why?

Yes

No No

4c. Are they are Heartworm preventative? If not, why?

Yes

No No

4d. Are they licensed? If not, why?

Yes

No No

4e. Have they taken their dogs to obedience training? If not, why?

Yes

No No

5. Why do they want a Dane? * 🛈

6. Where will they keep the Dane when they are away?

6a. During the day? *

6b. When on vacation? *

7. Where will the Dane sleep? *

8. What kind of fence do they have (rail, stockade, chain link, etc.)? *

8a. Is the fence permanent? *

8b. How high is the fence? *

8c. Does the fence complete enclose the backyard? If not, please explain. *

Yes

No No

8d. How big is the yard? *

8e. If no fence, is installation scheduled? Installation date?

Yes

No No

Please explain to the applicant that the home check will not be completed until the fencing is installed.

8f. Fencing exception required? *

Yes

No No

Explain that fencing exceptions are subject to Board approval and requires written references.

9. Do they: *

Own

Rent

9a. If rent, does lease stipulate large dogs?

Yes

No

Tell them we will need to see allowance in writing prior to home check.

10. Do they have any plans on moving in the next three years? If yes, please explain. *

Yes

No No

11. Are interior stairs covered with slip resistant tread? *

No Stairs

Yes

No

11a. If no, will they cover before home check?

Yes

No No

Please explain that the home check will not be completed until stair treads are installed.

12. Are there any water features on property? If so, please comment. *

13. How many people in family? If children, what are ages and sex? If no children, are there plans to have any in the future. *

14. Are any family members allergic to dogs? *

Yes

No

14a. If yes, what is their plan to be able to keep a dog in their home?

15. Do both adults work? *

No	Yes, Hours Yes, Hours

16. How long will dog be left alone without a potty break? *

16a. If longer than 6 hours, do they have a midday relief plan? Explain.

Yes

No No

You can estimate this from above but get them to verify estimate. If dog will be alone more than 6 hours (the maximum time recommended without dog being able to go outside to eliminate) explain ways to get him out (doggy door, dog walker; retired persons and pre-teens are good sources).

17. How do they feel about crate training? *

18. Danes often need unexpected and expensive surgery (bloat, acl surgery, etc.). What would you do if your Dane suddenly needed surgery costing $2000? *

19. Are they interested in a male or female, or does it matter? *

Male

Female

Does Not Matter

19a. What age range are they looking for? *

19b. Appearance Requests?

19c. Are they interested in specific orphans? If so, who? *

Yes

No No

19d. Do they have specific likes/dislikes? *

Ensure that they know of our policy of not doing same sex adoptions.

20. Will you agree to have all family members (including midday relief provider) present at the home evaluation? *

Yes	No, Why No, Why

Additional Questions for Potential Foster Home

21. How would they integrate a foster dog with their current pets?

22. How would they deal with a dogs negative behavior? (give an example like counter surfing, trash can diving, or resource guarding)

23. What would they do if a foster dog soiled the house?

24. Is their home set up so they can separate a foster dog from their own pets?

For All Applicants

Use this area to provide your overall impression of applicant. Did they seem genuine? Enthusiastic? Would you leave your dog with them?

Additional comments/observations *

Did you send them, or direct them to, an application? *

Yes

No

Suggested brochures for the home check volunteer to take along: *

Name of Interviewer: *

Newspaper	TV show	Flyer
Event	Adopter	Adopted from us
Other rescue	Other	Website
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