Dog Adoption 23

Dog Adoption Application

NOTE: Applications must be filled out completely to be considered for adopting a pet. Only approved adopters will be notified. Filling out an appliaction is not a guarantee that you will be approved to adopt a certain pet.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Phone Number*

Area CodePhone Number
Name of pet you wish to adopt (if known)
Gender?*

MaleFemaleDoesn't matter
Breed of dog desired?*

working dog: shepards, huskies, newfoundlandsHerding dog: border collie, austrailian cattle dogHound dog: beagle, greyhound, coonhoundSporting dog: labrador, retriever, spanielsNon-sporting dog: bulldog, poodle, boston terrierToy dog: chichuhua, shih tzusTerrier dog: jack russell, fox terrierno preference
Age of Desired Pet?*

8 weeks to 6 months6 months to 1 year1-3 years4-9 yearsSenior
Desired size of dog when fully grown?*

x-smalll, less than 10 poundssmall, between 11-20 poundsmedium 21-40 poundslarge, 41-65 poundx-large 66+
Do you:*

OwnRent
If rent, please provide Landlord's name, phone, and email:*
How many people live in the home- include ages:*
Is everyone in household aware of your intentions to adopt a pet?*

YesNo
Is there anyone in your home allergic to pets?*

YesNo
Who will be the primary caretaker?*
How many hours a day will the pet be home alone?*
Where will this pet stay when no one is home?*

whole houseone roomgaragebasementdog cratefenced in yardoutside tied upoutside kennel
Where will this pet sleep at night?*
Who will care for the pet when you go on vacation?*
Current or past veterinarian's name and phone:*
How much do you expect to spend (annually) on this new pet?*
Would you be able to come up with $500 for an emergency vet visit?*

YesNo
Have you or any adult living in your home ever had to surrender a pet? If yes, please explain:*
Pet History
List all pets that currently live in your home: (Name, type, age)*
If there are dogs currently in the home, have they been spayed or neutered?*

yesnohave vet appointment schedulednot yet, have vet appointment scheduled
Are there any cats in the home?*

yesno
Are your current pets up-to-date on vaccines?*

YesNononapplicable
Are your current pets on flea/tick preventative?*

YesNononapplicable
Are your current dogs on heart worm preventative?*

YesNononapplicable
What would be a reason you would consider giving away this pet? Check any/ all that apply:*

behavioral issuesfinancial issuespet medical issuemovingallergiesnew babyyour medical issuesdeploymentothernone, I won't give away
Have you ever owned a dog before?*

YesNoI lived with a dog but was not the primary owner
Hwo do you intend to exercise this dog*

play with other dogs in completely fenced in yardTake for walks on a leashTake for walks in the woods/ swimmingI am physically disabled and cannot exercise this dog
Will you keep your new dog on heart worm treatment and up-to-date on vaccines?*

YesNo
Do you have a fenced yard?*

CompletePartialInvisible electric fenceno, I will have to take out on a leash
I would like information on:

Housebreaking/Potty trainingStop chewingSeparation anxietyLeash trainingIntroducing new dog to current pets
__________________________________________________________
Have you or anyone in household ever been charged or convicted of animal neglect, cruelty or abuse, or domestic violence?*

YesNo
I understand that an animal can live 15-20+ years and I am fully committed to giving this new pet a permanent indoor forever home?*

YesNo
If you are no longer able to physically care for this pet, you have a family or friend who has agreed to take ownership and properly care for the pet?*

YesNono, I will have to take to a rescue
You are financially able to provide for the daily care as well as any required medical expenses necessary for the long-term care of this new pet?*

YesNo
_________________________________________________________________
- Humane Society of Saginaw County (HSoSC) rescued dogs and cats are examined by a veterinarian, vaccinated, parasite treated, and spayed or neutered before adoption. However, we can not guarantee the future health of our animals.
- Submitting an application does not obligate you to adopt nor does it guarantee the pet will be adopted to you.
- HSSC places the pet in the most suitable home, not the first applicant.
__________________________________________________________
- To the best of my knowledge, this application is complete and truthful.
- I give permission to Humane Society of Saginaw County to verify any information provided.
- I understand a home check may be mandatory before adopting a pet.
- I understand any false information may terminate a potential adoption.
Applicant signature:*
Should be Empty:

Dog Adoption Application