Dog Adoption Application

Name of Dog*

Impound #

Shelter Use Only

(Applicants must be at least 18 years of age)

Date*

Date

Name of potential adopters: 1.*

2.

Address*

Apt. #

City*

State*

Zip code*

Home phone*

Cell phone*

Email address*

example@example.com

Are the potential adopters employed?

Yes or No*

If No, please explain*

Ex. Retired, Student

If you rent, you must provide landlord’s information.*

Yes or No

Landlord’s name and phone

(If you rent, landlord approval is needed before the adoptable animal will be released to a home)

Number of adults living in the home (18 yrs or older)*

Number of children living full and/or part time in the home*

Ages of children

Does anyone living in the household have animal related allergies?*

Yes or No

Are you a first time dog owner?*

yes or no

What experience have you had owning a dog?*

Have you ever had to re-home a pet before?*

Yes or no

If yes, please explain

Have you ever had to put a pet to sleep before?*

Yes or no

If yes, please explain

Are there any other pets that currently reside in your home?*

Yes or No

If yes, what kind(s) and their

ages (if known)

If applicable, are they spayed or neutered?

If not, please explain

Where do they stay indoors, outdoors, etc?

Is there a yard?*

Yes or No

Is it fenced?*

Yes or No or Not applicable

There are financial responsibilities that comes with owning a pet. Besides food, treats and toys, there are annual veterinary exams and vaccines needed, chronic illnesses to care for and even unexpected

emergency expenses. Can you afford to properly care for the adoptable animal?*

Yes or No

Name of veterinary clinic that you currently use or intend on using*

What arrangements will you make for the care of the adoptable dog in case of emergency, or if you

become unable to care for the pet?*

If you move, will you make arrangements to take the dog with you?*

Yes or No

In what circumstances would you consider giving up a pet?*

The Parma Animal Shelter, Inc. is a non-profit organization. Our animals are not for sale, they are for adoption, which means a home must meet the approval before adoption a pet, including but not limited to filling out this form, discussion(s) with an adoption counselor, meeting with the prospective pet and a signed contract. In addition, the Parma Animal Shelter, Inc. reserves the right to turn down a prospective adoption at any time during this process for any reason. I assert that the information I have provided on this form is accurate and true, and have read and understand the above disclaimer.

By signing this application I understand that I am responsible for the well-being of the adoptable dog(s I will provide proper care and shelter. I will not abandon the adoptable dog(s) at any time. Dogs/puppies must be transported with a leash and collar.

Signature of applicant*

Clear

Date*

Date

Signature of applicant

Clear

Date

**Because you have signed this form does not mean you have been approved to adopt this animal.

Questions? Please contact dogadoptions@parmashelter.org

This section is to be completed by a Parma Animal Shelter, Inc. Adoption Counselor ONLY.

Parma Animal Shelter Dog Adoption Application