Dog Adoption Application
Please note: when applying to adopt, please only complete ONE application form per household.
Name of dog interested in adopting
*
Applicant Information
Applicant’s Name
*
Partner’s Name
Address
*
Apartment/Unit Number
City
*
Postal Code
*
Primary Phone Number
*
Format: (000) 000-0000.
Primary Phone Type
*
Home
Cell
Work
Secondary Phone Number
Format: (000) 000-0000.
Secondary Phone Type
Home
Cell
Work
Partner's Phone
Email Address (if you do not have an email, please put noemail@noemail.com)
*
example@example.com
Emergency Contact Information
Please list an emergency contact that does NOT live in your household.
Emergency Contact’s Name
*
Relationship to Applicant
*
Phone Number
*
Format: (000) 000-0000.
Household Information: Applicant
Complete the information for yourself below.
Are you 18+?
*
Yes
No
Please specify your age:
*
What is your occupation?
*
Working
Student
Other
What type of dwelling do you currently live in?
*
House
Semi-Detached/Townhouse
Condo/Apartment
Other
If you have a yard, is it fenced?
*
Yes
No
Don't have a yard
How high is the fence? (N/A if no fence)
*
What is the fence material? (N/A if no fence)
*
Household Information: Other Household Members
List the names, ages, relationships, and occupations of each person living in your household.
Person 1: First & last name
Person 1: Are they 18+?
Yes
No
Person 1: Age
Person 1: Relationship to applicant
Person 1: Occupation
Working
Student
Other
Person 2: First & last name
Person 2: Are they 18+?
Yes
No
Person 2: Age
Person 2: Relationship to applicant
Person 2: Occupation
Working
Student
Other
Person 3: First & last name
Person 3: Are they 18+?
Yes
No
Person 3: Age
Person 3: Relationship to applicant
Person 3: Occupation
Working
Student
Other
Person 4: First & last name
Person 4: Are they 18+?
Yes
No
Person 4: Age
Person 4: Relationship to applicant
Person 4: Occupation
Working
Student
Other
Who will be the primary caregiver for this pet?
*
Does anyone in your household show signs of allergies to dogs?
*
Yes
No
Sometimes
Unsure
Pet Ownership
Please list current and previous pets, including pets that have passed on. Select the appropriate response for each.
Pet 1: Name
Pet 1: Type & Breed
Pet 1: Age
Pet 1: Sex
Female
Male
Pet 1: Spayed/ Neutered
YES
NO
Pet 1: Declawed
YES
NO
Pet 1: Indoor/ outdoor
IN
OUT
BOTH
Pet 1: Where is the pet?
Still own
Deceased
Other
Pet 1: Ownership
Childhood pet
My pet
Other
Pet 2: Name
Pet 2: Type & Breed
Pet 2: Age
Pet 2: Sex
Female
Male
Pet 2: Spayed/ Neutered
YES
NO
Pet 2: Declawed
YES
NO
Pet 2: Indoor/ outdoor
IN
OUT
BOTH
Pet 2: Where is pet?
Still own
Deceased
Other
Pet 2: Ownership
My pet
Childhood pet
Other
Pet 3: Name
Pet 3: Type & Breed
Pet 3: Age
Pet 3: Sex
Female
Male
Pet 3: Spayed/ Neutered
YES
NO
Pet 3: Declawed
YES
NO
Pet 3: Indoor/ outdoor
IN
OUT
BOTH
Pet 3: Where is pet?
Still own
Deceased
Other
Pet 3: Ownership
My pet
Childhood pet
Other
Pet 4: Name
Pet 4: Type & Breed
Pet 4: Sex
Female
Male
Pet 4: Age
Pet 4: Spayed/ Neutered
YES
NO
Pet 4: Declawed
YES
NO
Pet 4: Indoor/ outdoor
IN
OUT
BOTH
Pet 4: Where is pet?
Still own
Deceased
Other:
Pet 4: Ownership
My pet
Childhood pet
Other
1. Have you ever had to give up an animal? If so, please explain the circumstances
*
2. In order to feed, provide medical and daily care for my new pet, I am prepared to spend the following per year:
*
3a. Please list the names of the veterinary clinics your pets have seen.
*
3b. When were their last vaccinations? (month and year)
*
3c. How often do your current pets go to the vet?
*
4. Understanding that all dogs may have unexpected medical needs, I am comfortable adopting a dog:
*
With no current health issues
Eating a vet prescribed diet
Taking medication
With ongoing medical conditions
5. How often do you plan to take your new dog to the vet?
*
Once every couple of years
Annually or more often
When sick
Not sure
Other
6. My dog will need to get along with (check all that apply):
*
Infants
Children
Visitors
Everyone they meet
My household
Dogs
Cats
Small Animals (rabbit etc)
Other
7. I would like my new dog to be (check all that apply):
*
A family companion
For guarding/protection
A service/therapy dog
Other
8. I am looking for a dog that is:
*
High energy (likes to be kept busy throughout the day and is very active)
Moderate energy (is happy with 1 to 2 walks a day)
Low energy (is a couch potato)
Other
9. What would a typical day for your new dog look like (eg a day where you are at work or following your normal routine)?
*
10. How many hours a day will your new dog be left alone?
*
11. When I am NOT home, my new dog will be (check all that apply):
*
Outdoors
In an outdoor run/pen
Allowed free access to home
On a tie out
At a dog day care
In a crate
Confined to a room
With a sitter or dog walker
Other
12. In my free time, I plan to spend time with my dog in the following ways (check all that apply):
*
Hiking
Off leash
Jogging
Relaxing at home
Dog Park
Playing with dog friends
Fetch
Visiting friends/family
Going for walks
Other
13. When I am AT HOME, my new dog will be (check all that apply):
*
Outdoors
In the garage
In a crate
In an outdoor pen/run
On a tie out
Confined to a room
Allowed free access to home
Wherever I am
14. At night, my new dog will be (check all that apply):
*
Outdoors
In the garage
In a crate
In an outdoor pen/run
On a tie out
Confined to a room
Allowed free access to home
Wherever I am
15. When if comes to training my new dog, I am comfortable with a dog that (check all that apply):
*
Will require very little training on my part
Will need to be house trained
Will require basic obedience training
Will require ongoing training tomodify difficult behaviours (eg. resource guarding, dog reactivity, separation anxiety etc)
Will enjoy advanced training (agility, flyball, herding, rally obedience)
16. Please describe how you would handle the following behaviours:
16a. Jumping up, mouthing and nipping
*
16b. Barking and lunging at another dog while on leash
*
16c. Pulling on leash (please include what walking equipment you would use)
*
16d. Guarding an item (eg food bowl, bone, toy, stolen item etc)
*
17. Please list any dog trainers, training schools, books or other resources you have used or referenced:
*
18a. Do you plan to take your new dog to training classes or lessons?
*
Yes
No
If required
18b. If you answered yes, do you have a trainer in mind?
*
19. Behaviours that I am NOT willing to work with, or situations that would cause me to return this animal are: (check all that apply)
*
Vocal
Shedding
Separation anxiety
Mouthing/biting
Medical issues arise
Fearfulness
Guarding food/toys
House soiling
Fighting with other pets
Too time consuming
Too difficult to train
Jumping on people
Dog reactivity
Destructive chewing
Grabbing clothes/limbs
Chasing cars/animals
Willing to work with all
Other
20. Please explain why this dog is the right fit for you/your family. (things to consider may be your lifestyle, expectations of a new pet, ongoing training this dog may require, and the specific medical and behavioural needs of the dog you are applying for).
*
21. Is there anything you would like more information on? e.g. dog trainers in my area, breed specific needs etc
*
22. If I move, I will
*
Take it with me
Find it a new home
Give it to a family member
Surrender it to an animal shelter
23. We'd love to know! How did you first find or hear about the animal you're interested in adopting?
*
HSOMH Website
HSOMH Facebook Page
HSOMH Instagram Page
HSOMH TikTok Page
HSOMH Newsletter
Facebook Group
Google Search
PetFinder
Media Outlet or Channel (news)
Referred to by Family or Friends
Walk-in Visit to the HSOMH Shelter
Community Event
Barkin' Bin Thrift Store
Other
Acknowledgement
By signing below:
I certify that I am at least 18 years of age and have the knowledge and consent of all adults living in my household.
I certify that the information I provide on this application is true and complete. I authorize the investigation of all stat
eme
nts contained on this
application and understand that the Humane Society of Oakville, Milton & Halton has the right to deny my request to adopt an animal.
I understand that this application is the property of the Humane Society of Oakville, Milton & Halton .
I understand that the Humane Society of Oakville, Milton & Halton may contact my veterinarian and I authorize access to any records held
by
that office in
regards to my current and past pets.
I would like to receive electronic communications from the Humane Society of Oakville, Milton & Halton, 445 Cornwall Road, Oakville, On. 905-845-1551. shelter@omhs.ca. I understand that I can unsubscribe at any time using the SafeUnsubscribe button at the bottom of every email. I would like to receive emails to the following email address:
example@example.com
Signature
*
FOR OFFICE USE ONLY :
Date
/
Month
/
Day
Year
Date
Animal Name(s)
SB#/Location
Adoption Phone Meeting
Adoption Pick-Up
Drivers Licence
Completed Review
SB -- Y / N Current Address -- Y/N
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