Dog Adoption Application

Name Of Dog

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Are you over 18?

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long have you lived at your current address

Resident Type

Do you rent or own?

If you rent, list your landlords name and phone number

Are animals allowed?

Size and number of animals allowed

Is there a pet deposit or additional pet rent required?

How much is the rent/deposit?

Does your job require extensive travel?

Have you ever owned a dog before?

Do you currently have any pets? What breeds?

Have your current pets been neutered or spayed?

Are your pets up to date on their vaccines?

Have you ever introduced a new pet into your home? How will you facilitate the new animal meeting your current ones?

Are you adopting this animal for you or for someone else?

Is this animal going to be:

Are you aware of the life expectancy of your animal?

Are you aware of the medical/housing/food costs associated with owning an animal?

Are there any pet allergies in your family?

Do all members of your family support this adoption?

Do you have any children in the household? What ages?

Have the children been instructed on proper care of an animal?

What do you know about this breed?

Have you had any experiences training?

Would you be willing to enroll your dog in obedience class?

How will you discipline your dog?

If you are adopting a puppy do you know how to housebreak an animal?

Have you ever surrendered an animal of your own into an animal shelter before?

If you have surrendered an animal, please explain why

Have you ever had to rehome an animal (to a new home other than a shelter)?

If you have had to rehome an animal, please explain why

For what reasons would you return this animal to us?

Where will the animal be during the day?

What outside space is available?

Approximate area of the yard/height of the fence

Do you have a pet door, if so where does it lead to?

If an outside pet, what shelter do you have for it?

How much time a day will your pet be alone? (without human companionship)

Where will your animal spend its time away from you?

How will you exercise your dog?

What will you do with the dog if you go on vacation?

What arrangements will you make for the care of your pets in case of an emergency or if you become unable to care for them?

Name and number of veterinarian

What is the most common reason you have visited the vet?

Are you aware of the high cost of shots and regular veterinarian costs?

Can you afford to pay for the veterinarian costs for the animals life time?

If you move, what will you do with your pet?

What will you do with your animal if for any other reason you can no longer care for it

Have you ever had an animal impounded or been issued a citation for an animal law violation?

If yes, please explain

I would like to discuss the following with my adoption counselor:

I certify that the information given on this application is true and accurate to the best of my knowledge. In understand that providing any false information can be cause for denial of my application or future forfeiture of the adopted pet. Leaving any question blank or not filling out this form completely can be cause for the application to be discarded or denied. By choosing to adopt, I understand that I am expected to make a considerate commitment of time and money to this animal for his/her lifetime, up to 20 years in some cases.

Please sign

I understand that WHHS may make periodic house visits and /or telephone inquires to ensure the well-being of the animal I am adopting. I agree to cooperate full and thoughtfully with WHHS inquires and to allow WHHS to see my animal upon request. In understand that WHHS has the right to take possession of the animal, at its discretion, if during a visit WHHS determines that animal is not being properly cared for.

please sign

If the animal is not already spayed or neutered there is an additional $75.00 spay/neuter deposit that is refundable once we receive notice that the spay or neuter procedure is done by the date indicated on your health exam and spay/neuter contract.

please sign

“I understand the terms and conditions of this adoption and acceptable responsibility for its known and unknown health issues.”

please sign

I, the undersigned, hereby release the Western Hills Humane Society from any and all liabilities pertaining to the adoption of the above-mentioned animal.

please sign