TLC Rescue: Dog Adoption Application

HSOC Dog Adoption Application

Ruth's Memorial Shelter
All dog adoption fees are $200. The minimum age to adopt is 21 years old.

This fee includes the spay/neuter, microchip, age appropriate/current vaccines, deworming, heartworm test, and heartworm/flea & tick prevention.

The Humane Society of Concord reserves the right to reject any application based on information obtained during this screening process. Submitting an online application does not mean you are commiting to a dog, nor does it guarantee you will be approved to adopt the dog you're interested in. It is simpy a tool we use to help both you and us identify a good potential match for your family and lifestyle. Incomplete applications or ones that do not follow any stated qualifications needed for a specific animal may not be reviewed. Please understand that our primary goal is the health, happiness, and safety of our rescued dogs.

A successful adoption depends on selecting the right dog for your household and a good understanding of the dog's needs and care requirements. Please help us with this process by answering the following questions fully & completely. THANK YOU!
Name of the dog you want to adopt*
Today's Date
Applicant's Information
Applicant's Name*

First NameLast Name
Applicant's Preferred Pronouns

He/HimShe/HerThey/ThemOther
Applicant's Birthday*

MonthDayYear
Date
Spouse/Partner's Name

First NameLast Name
Driver's License Number & Issuing State*

StateNumber
Spouse/Partner's Driver's License Number & Issuing State

StateNumber
Applicant's E-mail. *Please use a good email as an adoption counselor will reach our via email regarding your application.**
example@example.com
Spouse/Partner's E-mail
example@example.com
Phone Number*
Phone Type*

CellHomeWork
Applicant's Employer*
Employer's Phone Number
Do you work outside the home?*

YesNoOne applicant is home/works from homeWe work different shifts
How many hours per day will this dog be alone due to work schedule? Please explain.*
Applicant's Address*

Street Address

Street Address Line 2

CityState

Zip Code
I/We live in a*

Single Family HomeDuplexCondo/TownhomeTrailerApartment
Are you the homeowner?*

Yes, I own this homeNo, I rent this homeNo, I live with the homeowner/parents
Name of Landlord or Homeowner. Please also add the apartment complex name and number if renting. If you are the owner, please put your name.*
Renters, have you contacted your landlord to find out if there's any restrictions on the breed, age, or size of dog you can have where you live?*

YesNoNot yet, but I willIt's written in our leaseN/A
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations.
Do you have a yard? We do not required a fenced in yard for general adoptions, but certain dogs may require one.*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
Nearest Relative/Emergency Contact*

First NameLast Name
Nearest Relative/Emergency Contact's Phone Number*
Have you ever been convicted of a crime?*

YesNo
If you answered "Yes" for the question above, please explain:
Current & Past Pet's Informtation
Do you currently have any pets?*

YesNo
If you currently have pets, please list them below (make sure to include name, breed, age, sex):*
Do you have a veterinarian?*

NoYes
Veterinarian's Information - Include the facility name and number. (Please call your vet and give permission to release information to us)*
Are your current pets vaccinated? This includes Rabies vaccine AND Distemper/Parvo vaccine (dog).*

YesNoN/A (only choose if you do not currently have any pets)
Are your current pets on heartworm prevention (monthly pill or injection)?*

YesNoN/A (only choose if you do not currently have any pets)
Are your current pets altered?*

YesNoNo my current pets are not altered, but an appointment has been scheduled for the surgery. (We will call your vet to verify this).
If your current pets are not altered, please explain why below.
How many pets have you owned in the last 10 years? Also list what has became of each of them.*
Where do your pet's currently live?*

IndoorsOutdoorsBoth
Where will the pet you're interested in live?*

IndoorsOutdoorsBoth
If you answered "Both" for either question above please explain below:
Have you ever relinquished an animal to Animal Control? If yes, please explain below:*
Are you familiar with vaccine requirements?*

YesNoSomewhat
Are you familiar with heartworm prevention?*

YesNoSomewhat
Do you plan to get pet health insurance?

YesNoI wasn't aware this was available. I will look into it.
Additional Questions
Are you planning to move in the near future?*

YesNo
If moving soon, to what city/state?
Is anyone in your home allergic to dogs?*

YesNo
Does anyone in your home fear dogs?*

YesNo
Does anyone in your home smoke?*

YesNo
Names and ages of all permanent residents of your home (adults/children)*
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
We will be speaking to all adult residents to confirm everyone is aware of this application process and wants to have a dog added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this dog or think "once they meet the dog, they will want one" or "I'm getting this dog as a surprise birthday present for them." In those scenarios, you are welcome to email us to discuss the dog, but we would like all adults in the home to be involved in that email discussion.
Upon meeting the dog, what would give you cause to not want to adopt? Please explain.*
Fantasy question: What would your dream dog be like? (If this dog is not a fit, we may be able to recommend another based on what you say here.)*
What activity/energy level do you prefer?*

Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOther
Please check all that apply. I want to adopt this dog...*

As a family petAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/childrenTo breed with my dogTo train/use for huntingTo train/use as a therapy dogTo train/use as service dogTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friend, partner, or family member
Please check all that apply. My adopted dog will...*

Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 10Be interacting frequently with children over 10Need to be housebroken prior to adoptionBe housetrained by usBe walked dailyBe walked occasionallyBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to another shelter if we can't keep itBe going camping with usBe going on boat trips with usBe kept outside with a dog house in a fenced areaBe kept outside chained/tethered to a dog houseBe free roaming on the farm (unfenced)Other
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

Housetraining/Crate TrainingObedience TrainingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingBlindnessDeafnessSeparation AnxietySpecial DietLong Term MedicationIncontinence / Leaking UrineGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionDiabetesSkin allergiesFood allergiesHeartworm preventativeI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
For what reason (if any) would you return this dog? (i.e. marriage/divorce, moving, new baby, etc)*
Have you considered the expense of this dog, both routine and unexpected? (Yearly exams and vaccines, monthly heartworm prevention, emergency vet visits, food, toys/enrichment, daycare, grooming, boarding, etc) *
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?*
How did you hear about Ruth's Memorial Shelter or the dog that you're interested in?*
Application Agreements
I understand that completing this application does not guarantee I will be allowed to adopt a dog, and that the application is a tool to help The Humane Society of Concord determine if this dog and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved. I understand that if I'm applying for a dog that has specific stated qualifications (i.e. breed experience) and my application does not meet these qualifications, it will NOT be reviewed and I may not be contacted. I also certify that I have never been convicted of animal cruelty or neglect.

I agree to allow a representative from The Humane Society of Concord to contact my veterinarian for a reference. If I am approved to adopt a dog, I agree to pay a non-refundanble adoption fee and sign a legal adoption contract at the time of adoption.
Please read the above, check these boxes, and click Submit.*

I/We have read and understand all of the above.I/We understand that the turnaround time on all online applications is 72 hours.
Animal Parents: If you have online records for your current animals, you can upload them below. Renters: Please send a copy of the pet section of your lease or a landlord pet permission letter to RMS.adoptionapps@gmail.com or upload file below.

Cancelof
Should be Empty:

HSOC Dog Adoption Application

Applicant's Information

Current & Past Pet's Informtation

Additional Questions

Application Agreements