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QUESTIONNAIRE
[For Adoption]

Thank you for contacting Gjnjah Tibetan Spaniels.  Please complete the following form to be considered for a Tibbie adoption/placement, since all our dogs are sold to approved homes only.

 

 

I.               Contact Information:

 

*First Name:        ________________________

 

*Last Name:         ________________________

 

*Street Address: _______________________________________

 

*City: ______________________________________________

 

*State/Province: ______________________________________

 

*Zip/Postal Code: ______________________

 

*Country: ____________________________

 

*PHONE [Daytime]: ____________________________

 

*PHONE [Evening]: ____________________________

 

*PHONE [Other]: ______________________________

 

*E-Mail: ____________________________

 

*Website: ____________________________

 

 

 

 

-1-

 

II.            List all family members living at home [ages]:

 

_________________________________________________________________


_________________________________________________________________

 

_________________________________________________________________

 

 

III.         Do you have a fenced yard or secure environment if your Tibetan Spaniel is outside [please explain in detail]?

 

 

 

 

 

IV.          Do you have any other dogs/pets?  YES/NO

 

If YES, please provide details; how many, age, type

 

 

 

 

 

 

V.     Approximately how many hours per day would the puppy/dog  be left alone if you work?

 

 

 

 

 

 

VI.          Have you ever placed a pet in a SHELTER or with a RESCUE CLUB, such as the

Humane Society?  YES/NO

 

 

 

 

 

VII.   Your VETERINARIANS Name, Address, Phone Number:

 

 

 

 

 

 

 

-2-

 

VIII.    Please provide TWO references with PHONE NUMBERS:

 

1]

 

 

 

2]

 

 

 

IX.          Would you be willing to let someone do a home visit?

 

 

 

X.             What gender are you interested in owning?

 

MALE

 

FEMALE

 

 

XI.          How did you find out about the Tibetan Spaniel? 

 

 

 

XII.       How did you find GJNJAH TIBETAN SPANIELS?

 

 

 

XIII.    List any other important information you think I would find useful in placing one of my Tibetan Spaniels in your care.

 

 

 

 

 

 

 

Gjnjah Tibetan Spaniels

Gina Podsednik

304 Diamond Lane

Burleson, Texas  76028

817-426-3260

 

 

-3-

Gjnjah Tibetan Spaniels

 

Placement Questionnaire

 

Thank you for contacting Gjnjah Tibetan Spaniels.  Please complete the following form to be considered for a Tibbie adoption/placement, since all our dogs are sold to approved homes only.

 

 

I.               Contact Information:

 

*First Name:        ________________________

 

*Last Name:         ________________________

 

*Street Address: _______________________________________

 

*City: ______________________________________________

 

*State/Province: ______________________________________

 

*Zip/Postal Code: ______________________

 

*Country: ____________________________

 

*PHONE [Daytime]: ____________________________

 

*PHONE [Evening]: ____________________________

 

*PHONE [Other]: ______________________________

 

*E-Mail: ____________________________

 

*Website: ____________________________

 

 

 

 

-1-

 

II.            List all family members living at home [ages]:

 

_________________________________________________________________


_________________________________________________________________

 

_________________________________________________________________

 

 

III.         Do you have a fenced yard or secure environment if your Tibetan Spaniel is outside [please explain in detail]?

 

 

 

 

 

IV.          Do you have any other dogs/pets?  YES/NO

 

If YES, please provide details; how many, age, type

 

 

 

 

 

 

V.     Approximately how many hours per day would the puppy/dog  be left alone if you work?

 

 

 

 

 

 

VI.          Have you ever placed a pet in a SHELTER or with a RESCUE CLUB, such as the

Humane Society?  YES/NO

 

 

 

 

 

VII.   Your VETERINARIANS Name, Address, Phone Number:

 

 

 

 

 

 

 

-2-

 

VIII.    Please provide TWO references with PHONE NUMBERS:

 

1]

 

 

 

2]

 

 

 

IX.          Would you be willing to let someone do a home visit?

 

 

 

X.             What gender are you interested in owning?

 

MALE

 

FEMALE

 

 

XI.          How did you find out about the Tibetan Spaniel? 

 

 

 

XII.       How did you find GJNJAH TIBETAN SPANIELS?

 

 

 

XIII.    List any other important information you think I would find useful in placing one of my Tibetan Spaniels in your care.

 

 

 

 

 

 

 

Gjnjah Tibetan Spaniels

Gina Podsednik

304 Diamond Lane

Burleson, Texas  76028

817-426-3260

 

Gjnjah Tibetan Spaniels

 

Placement Questionnaire

 

Thank you for contacting Gjnjah Tibetan Spaniels.  Please complete the following form to be considered for a Tibbie adoption/placement, since all our dogs are sold to approved homes only.

 

 

I.               Contact Information:

 

*First Name:        ________________________

 

*Last Name:         ________________________

 

*Street Address: _______________________________________

 

*City: ______________________________________________

 

*State/Province: ______________________________________

 

*Zip/Postal Code: ______________________

 

*Country: ____________________________

 

*PHONE [Daytime]: ____________________________

 

*PHONE [Evening]: ____________________________

 

*PHONE [Other]: ______________________________

 

*E-Mail: ____________________________

 

*Website: ____________________________

 

 

 

 

-1-

 

II.            List all family members living at home [ages]:

 

_________________________________________________________________


_________________________________________________________________

 

_________________________________________________________________

 

 

III.         Do you have a fenced yard or secure environment if your Tibetan Spaniel is outside [please explain in detail]?

 

 

 

 

 

IV.          Do you have any other dogs/pets?  YES/NO

 

If YES, please provide details; how many, age, type

 

 

 

 

 

 

V.     Approximately how many hours per day would the puppy/dog  be left alone if you work?

 

 

 

 

 

 

VI.          Have you ever placed a pet in a SHELTER or with a RESCUE CLUB, such as the

Humane Society?  YES/NO

 

 

 

 

 

VII.   Your VETERINARIANS Name, Address, Phone Number:

 

 

 

 

 

 

 

-2-

 

VIII.    Please provide TWO references with PHONE NUMBERS:

 

1]

 

 

 

2]

 

 

 

IX.          Would you be willing to let someone do a home visit?

 

 

 

X.             What gender are you interested in owning?

 

MALE

 

FEMALE

 

 

XI.          How did you find out about the Tibetan Spaniel? 

 

 

 

XII.       How did you find GJNJAH TIBETAN SPANIELS?

 

 

 

XIII.    List any other important information you think I would find useful in placing one of my Tibetan Spaniels in your care.

 

 

 

 

 

 

 

Gjnjah Tibetan Spaniels

Gina Podsednik

304 Diamond Lane

Burleson, Texas  76028

817-426-3260

 

 

-3-

 

-3-

Gjnjah Tibetan Spaniels

 

Placement Questionnaire

 

Thank you for contacting Gjnjah Tibetan Spaniels.  Please complete the following form to be considered for a Tibbie adoption/placement, since all our dogs are sold to approved homes only.

 

 

I.               Contact Information:

 

*First Name:        ________________________

 

*Last Name:         ________________________

 

*Street Address: _______________________________________

 

*City: ______________________________________________

 

*State/Province: ______________________________________

 

*Zip/Postal Code: ______________________

 

*Country: ____________________________

 

*PHONE [Daytime]: ____________________________

 

*PHONE [Evening]: ____________________________

 

*PHONE [Other]: ______________________________

 

*E-Mail: ____________________________

 

*Website: ____________________________

 

 

 

 

-1-

 

II.            List all family members living at home [ages]:

 

_________________________________________________________________


_________________________________________________________________

 

_________________________________________________________________

 

 

III.         Do you have a fenced yard or secure environment if your Tibetan Spaniel is outside [please explain in detail]?

 

 

 

 

 

IV.          Do you have any other dogs/pets?  YES/NO

 

If YES, please provide details; how many, age, type

 

 

 

 

 

 

V.     Approximately how many hours per day would the puppy/dog  be left alone if you work?

 

 

 

 

 

 

VI.          Have you ever placed a pet in a SHELTER or with a RESCUE CLUB, such as the

Humane Society?  YES/NO

 

 

 

 

 

VII.   Your VETERINARIANS Name, Address, Phone Number:

 

 

 

 

 

 

 

-2-

 

VIII.    Please provide TWO references with PHONE NUMBERS:

 

1]

 

 

 

2]

 

 

 

IX.          Would you be willing to let someone do a home visit?

 

 

 

X.             What gender are you interested in owning?

 

MALE

 

FEMALE

 

 

XI.          How did you find out about the Tibetan Spaniel? 

 

 

 

XII.       How did you find GJNJAH TIBETAN SPANIELS?

 

 

 

XIII.    List any other important information you think I would find useful in placing one of my Tibetan Spaniels in your care.

 

 

 

 

 

 

 

Gjnjah Tibetan Spaniels

Gina Podsednik

304 Diamond Lane

Burleson, Texas  76028

817-426-3260

 

 

-3-

Gjnjah Tibetan Spaniels

 

Placement Questionnaire

 

Thank you for contacting Gjnjah Tibetan Spaniels.  Please complete the following form to be considered for a Tibbie adoption/placement, since all our dogs are sold to approved homes only.

 

 

I.               Contact Information:

 

*First Name:        ________________________

 

*Last Name:         ________________________

 

*Street Address: _______________________________________

 

*City: ______________________________________________

 

*State/Province: ______________________________________

 

*Zip/Postal Code: ______________________

 

*Country: ____________________________

 

*PHONE [Daytime]: ____________________________

 

*PHONE [Evening]: ____________________________

 

*PHONE [Other]: ______________________________

 

*E-Mail: ____________________________

 

*Website: ____________________________

 

 

 

 

-1-

 

II.            List all family members living at home [ages]:

 

_________________________________________________________________


_________________________________________________________________

 

_________________________________________________________________

 

 

III.         Do you have a fenced yard or secure environment if your Tibetan Spaniel is outside [please explain in detail]?

 

 

 

 

 

IV.          Do you have any other dogs/pets?  YES/NO

 

If YES, please provide details; how many, age, type

 

 

 

 

 

 

V.     Approximately how many hours per day would the puppy/dog  be left alone if you work?

 

 

 

 

 

 

VI.          Have you ever placed a pet in a SHELTER or with a RESCUE CLUB, such as the

Humane Society?  YES/NO

 

 

 

 

 

VII.   Your VETERINARIANS Name, Address, Phone Number:

 

 

 

 

 

 

 

-2-

 

VIII.    Please provide TWO references with PHONE NUMBERS:

 

1]

 

 

 

2]

 

 

 

IX.          Would you be willing to let someone do a home visit?

 

 

 

X.             What gender are you interested in owning?

 

MALE

 

FEMALE

 

 

XI.          How did you find out about the Tibetan Spaniel? 

 

 

 

XII.       How did you find GJNJAH TIBETAN SPANIELS?

 

 

 

XIII.    List any other important information you think I would find useful in placing one of my Tibetan Spaniels in your care.

 

 

 

 

 

 

 

Gjnjah Tibetan Spaniels

Gina Podsednik

304 Diamond Lane

Burleson, Texas  76028

817-426-3260

 

 

-3-

Gjnjah Tibetan Spaniels

 

Placement Questionnaire

 

Thank you for contacting Gjnjah Tibetan Spaniels.  Please complete the following form to be considered for a Tibbie adoption/placement, since all our dogs are sold to approved homes only.

 

 

I.               Contact Information:

 

*First Name:        ________________________

 

*Last Name:         ________________________

 

*Street Address: _______________________________________

 

*City: ______________________________________________

 

*State/Province: ______________________________________

 

*Zip/Postal Code: ______________________

 

*Country: ____________________________

 

*PHONE [Daytime]: ____________________________

 

*PHONE [Evening]: ____________________________

 

*PHONE [Other]: ______________________________

 

*E-Mail: ____________________________

 

*Website: ____________________________

 

 

 

 

-1-

 

II.            List all family members living at home [ages]:

 

_________________________________________________________________


_________________________________________________________________

 

_________________________________________________________________

 

 

III.         Do you have a fenced yard or secure environment if your Tibetan Spaniel is outside [please explain in detail]?

 

 

 

 

 

IV.          Do you have any other dogs/pets?  YES/NO

 

If YES, please provide details; how many, age, type

 

 

 

 

 

 

V.     Approximately how many hours per day would the puppy/dog  be left alone if you work?

 

 

 

 

 

 

VI.          Have you ever placed a pet in a SHELTER or with a RESCUE CLUB, such as the

Humane Society?  YES/NO

 

 

 

 

 

VII.   Your VETERINARIANS Name, Address, Phone Number:

 

 

 

 

 

 

 

-2-

 

VIII.    Please provide TWO references with PHONE NUMBERS:

 

1]

 

 

 

2]

 

 

 

IX.          Would you be willing to let someone do a home visit?

 

 

 

X.             What gender are you interested in owning?

 

MALE

 

FEMALE

 

 

XI.          How did you find out about the Tibetan Spaniel? 

 

 

 

XII.       How did you find GJNJAH TIBETAN SPANIELS?

 

 

 

XIII.    List any other important information you think I would find useful in placing one of my Tibetan Spaniels in your care.

 

 

 

 

 

 

 

Gjnjah Tibetan Spaniels

Gina Podsednik

304 Diamond Lane

Burleson, Texas  76028

817-426-3260

 

 

-3-

.