Dog Adoption Application
Name of Pet(s) You Would Like to Adopt
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Name of Primary Contact
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First Name
Last Name
Name of Secondary Contact
First Name
Last Name
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived at this address?
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Phone Number
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Please enter a valid phone number.
Phone Number
Please enter a valid phone number.
Current Age
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Please Select
Less than 18 years
18-20 years
21-25 years
26-30 years
31-35 years
36-40 years
41-45 years
46-50 years
51-55 years
56-60 years
61-65 years
66-70 years
71-75 years
76-80 years
81-85 years
86-90 years
91-95 years
96-100 years
101+ years
Who is the animal for? (Myself, family, friend, gift for someone else, etc.)
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Do you have children under 18 years of age?
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Please list ages of all members of your household including those that are only living with you part time if applicable.
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Do you have pets at home?
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If you have pets at home please tell us about them. (Name, type of pet, age and if they are spayed or neutered if appropriate)
If you have other pets currently, are they up to date on vaccinations?
Have you owned pets other than those listed above within the past 10 years?
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If you have owned other pets please tell us about them. (Name, type of pet, what happened to them (rehomed, passed away, lost, etc.))
Do you live in a house, mobile home, apartment, camper, etc.?
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Do you own or are you renting?
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If renting, please provide your landlord or leasing office name and contact phone number.
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Does your lease, HOA, or other oversight have pet restrictions? (Breed limitations, Weight limitations, limit to number of pets, etc.?)
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Does you home have a fenced yard?
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What is the height and type of fence? (privacy, chain link, woven wire, etc.)
Are you expecting any major life changes within the next 12 months? (Marriage, divorce, new baby, moving, etc.) Please explain.
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Will your new pet live inside or outside? Why?
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How will daily exercise be achieved?
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On average, how many hours will your pet be left alone daily?
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Have you considered the damage a pet can do? (chewing, scratching, soiling, etc.)
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Have you ever owned a dog or puppy that tested or was suspected to have parvovirus? If yes, when?
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How much do you expect to spend on care for your pet annually?
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If your pet becomes sick or injured in the future are you financially able to provide care for your pet?
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Please provide the name and phone number to your veterinarian.
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What name will the records be listed under?
How long have you been a client of this veterinarian?
Please provide the name and phone number of two personal references that are not related to you.
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The Clark County Animal Shelter makes every effort to successfully place animals into loving homes. Animals come into our care in a variety of ways. The information provided about each animal is true and honest to the best of our knowledge but no guarantees can be made about the the animal including but not limited to health, temperament, behavior, size, age or breed. Please type your first and last name once you have read and agree to this statement.
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By clicking "submit" I agree to allow Clark County Animal Shelter staff and designees to review, investigate and verify information provided in this application. Please type your first and last name once you have read and agree to this statement.
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Submit
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