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Adoption Questionnaire
Our Adoption Process: Fill out questionnaire as completely and honestly as possible. There are no wrong answers! Have a conversation with an Adoption Coordinator A volunteer will visit your home while we speak with your landlord and vet(s) (if applicable)
Tell us about yourself … (feel free to continue on the back!) Name | Carmen Levinson | E-mail | levinsor@aol.com | Street Address | 4960 Gainsborough DR Burke VA | Housing Type: (if apartment note number) | house | City | Fairfax | State | VA | Zip | 22032 | Home Phone | 7035033284 | Cell Phone | 7038018997 | Work Phone | | Are you renting? Do you have breed/size/number or weight restrictions? Can you provide proof? (Please provide landlord name and phone) | We own our home | Employer/School | Fairfax Radiology | How many people live in your home? (Please provide ages and relationship) | 4 people my husband and I and our two sons who are 14 and 17 | What is your daily schedule? How long are you away from home on any given day? | 11 am – 2:20pm we aare away the rest of the day were home | A young husky would be our dream dog | What dog(s) are you interested in (Please provide name from website) | Alaska or Prince | What age dog? | Juvenile (6 months -3 yrs) | Do you have a sex preference? | no preference | Do you have a breed preference? | Husky mix | Do you have a size preference? | Medium (25-50 lbs) or Large (over 50 lbs) ideally. | What characteristics are you looking for in a dog? | Lots of energy | What “normal” dog/puppy behavior challenges are you prepared to deal with? (e.g., chewing, housebreaking, barking etc.) | plenty | What behaviors concern you the most? Would these cause you to return the dog to Lucky Dog? | None really | What exercise plans do you have for your dog? Do you plan on hiring a dog walker? Enrolling in obedience school? | Both of my sons are wrestlers and need to go on daily runs so they would take him/her with them. | Please provide the name and age of all current pets. If you have had previous pets, please provide their names and what happened to them. | No current pets but but I grew up in a house with 16 dogs and my husband had one when he was young. | Please provide the name and phone number of the vet you use for your current pets and/or the name/phone number of the vet you used for previous pets. | none |

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