DOG ADOPTION APPLICATION

Please initial the following statements indicating that you agree and understand:

I am at least 18 years of age.*

Date of Birth:*

I understand that FDLHS has the right to deny or accept my application. *

I realize that FDLHS does not adopt on a first come, first serve basis- each animal will go to the home that is the best fit for the animals' individual needs. *

I understand that any current dogs I own must be spayed or neutered before I adopt a new animal. *

First Name:*

Middle Name:*

Last Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:*

Email Address:*

example@example.com

Who else lives in your household? Please full names and ages:*

Please describe your household- is it quiet, active, calm, noisy, etc.?*

If you rent, are you aware of your pet policies?*

YesNo

Do you have a regular veterinarian?*

YesNo

Do you agree to provide your new pet with regular health care by a licensed veterinarian?*

YesNo

Please list all of your current pets:*

Are all of your current dogs current on their Rabies Vaccine?*

YesNo

Name of the dog(s) in our care that you wish to adopt:

1st Choice:*

2nd Choice:*

3rd Choice:*

Describe your ideal dog, including desired age, size, etc.

Has anyone in your household ever been accused of or convicted of a charge related to abuse or cruelty to animals?*

YesNo

Have you applied to adopt or adopted from the FDLHS before*

YesNo

I understand that it takes time for an animal to adjust to a new environment, and that it can take up to 3 months for them to fully adjust and settle in. (please initial)*

Do you agree to keep any pet you adopt from us as an indoor pet?*

YesNo

I understand that some shelter animals may require more time, training, and patience than others. I also understand that FDLHS cannot guarantee that any dog is fully trained or housebroken, or any personality traits of the dog. (please initial)*

I certify that the information I have provided is true and accurate, and that any misrepresentations may result in my losing the privilege of adopting a pet. I understand that FDLHS has the right to deny any application and authorize them to verify any statements in this application. (please initial)*

As an applicant to adopt a pet at the Fond du Lac Humane Society, I understand that I will be interacting and handling animals to find the best fit for my family. I understand that I may take on any number of risks interacting with live animals. I acknowledge that I may be exposing myself to potentially significant health risks or serious medical conditions, including, but not limited to: injuries from slips and/or falls, bites or scratches, infectious diseases, parasites, allergic reactions, etc. Since the background of shelter animals cannot be verified, I understand that they can be unpredictable, and acknowledge that the Fond du Lac Humane Society cannot make any representation on any animals temperament, behavior, house training status, etc. I must rely on my own judgement, and I understand that interacting with any shelter animal is at my own risk. I agree to hold the Fond du Lac Humane Society, it’s employees, volunteers, agents, and directors, whether collectively or individually, harmless and not liable for any injury or liability any shelter animal may cause to me. I further assume all liability for damages to myself and any person I bring with me to interact with animals.

Signature *

Date*

Date

DOG ADOPTION APPLICATION

Contact Information:

Family & Housing:

Current Pets & Veterinarian Care:

Adoptable Dog Information:

Acknowledgements:

Waiver: