Canine Adoption Application Form

Canine Adoption Application
Thank you for your interest in adopting from BCHS!

We sincerely hope we can be of service to you. We ask that you fill out your application completely and truthfully. This application is designed to help us determine if the adoption is in the best interest of the animal and to assist the potential adopter in finding an animal most compatible with his/her lifestyle. We hope you will agree that the animal’s welfare must be our foremost consideration.
Full Name*

First NameLast Name
Date of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
BCHS will follow up with you after you submit your application. What is your preferred method of communication?*

EmailPhone (Home/Cell)Phone (Work)
What is the best day/time for us to reach out to you?*
Phone Number - Home/Cell*

Area CodePhone Number
Phone Number - Work

Area CodePhone Number
E-mail
Occupation and place of employment*

OccupationEmployer
Do you live in a:*
Do you:*

OwnRentLive with ParentsOther
If renting: Do you have your landlord's permission to adopt the type of animal you are interested in?

YesNo
If renting: Please indicate landlord contact information
How long have you lived at your current address?*
Do you anticipate moving soon?
If you move in the future, what will you do with your pet(s)?*
Please list all people living in the household.(Include name, relationship, and age)*
Who will have the main care responsibilities for the animal?*
Does any member of your household have allergies to dogs?*

YesNo
Does anyone in your household smoke inside?*

YesNo
Have you ever had a dog before?*

YesNo
If so, what breed and for how long?*
If you no longer have that pet, what happened to it/them?
Do you currently have other pets living in your home?*

YesNo
Please list all pets currently living in your home. (Include name, species, breed, sex, spay/neuter status, age)*
What will you do if the dog doesn’t get along with your present pet(s)?*
Will this dog be kept mainly as an inside or outside pet?*

Mainly insideMainly outside
If outside, how do you plan on keeping the dog confined to your property?*
If outside, what kind of shelter will be provided for your pet?*
Is this shelter currently available on your property? *
Where will the dog be kept during the day?*
Where will the dog be kept during the night?*
Where will the dog be kept when no one is home?*
Approximately how many hours will this dog be left alone each day?*
Will your new dog be kept on a chain at anytime?*

YesNo
If so, for how long?*
What will happen to the dog when you go on vacation or in the case of an emergency?*
Name and description of dog desired *
Why are you interested in adopting this particular dog?
Have you ever adopted from us, any other humane society, animal shelter, or rescue before?*

YesNo
If you answered yes to the question above, please list the organization(s).
If you are interested in a puppy, what method of housebreaking will you use?
How will this dog be exercised? How often?*
Have you ever been charged or convicted of any form of animal cruelty or neglect?*

YesNo
How much time will you allow your new animal to adjust to your household?*
If your pet gets lost, what will you do to try to find it? (Please remember that your dog's microchip is not a GPS device)*
Are you aware of the financial burden and commitment of owning a pet? (It costs approximately $800 a year just for food.)*

YesNo
Are you aware of the annual vaccinations needed for your pet(s)?*

YesNo
Please list your current vet and their phone number.

Vet NameVet Phone Number
What brand and type of food do you plan on feeding your new dog?*
How often will you groom and bathe your new pet?*
Do you realize dogs often live longer than 15 years?*

YesNo
Are you willing to assume responsibility for this animal for that long?*

YesNo
Do you plan on any alterations (ear cropping or tail docking)?*

YesNo
Would you object to a follow-up by a BCHS representative after your potential adoption?*

YesNo
If yes, why?
Please include any additional comments or questions here:
By submitting this application electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the nullification of adoption from Bartholomew County Humane Society.

I certify that the above information is correct, and I understand that the information will be verified.
Today's date*

MonthDayYear
Should be Empty:

Canine Adoption Application

Thank you for your interest in adopting from BCHS!