Dog Adoption Application

Date

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Phone

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

Secondary Phone

*It is best to list two phone numbers for your Petlink Microchip in the event your pet is lost.Format: (000) 000-0000.

Do you:

Are there any restrictions on animal ownership at your residence?

Have you had a dog before?

This pet is for:

Please list pets currently livining in your home. Click "Add New" to add more pets.

Do you currently have a veterinarian for your pets?

Please provide Dr Name, Clinic/Hospital Name, Location

How many adults over age 18 live in your home?

How many children live in your home

Please list how many, and their age range

What qualities are you looking for in your new pet? Check all that apply.

This dog will live

What topics do you have questions or concerns about?

I understand that submission of an adoption application does not guarantee approval of the application and that WCAS maintains the right to deny any application

FOR WCAS USE ONLY

Applican'ts ID (DL/SSN) _____________________________________________

Adoption: ____Onsite ____Offsite: (location) __________________________

Animal ID# ___________________________ Dog ___ Cat___ Other___

Reviewed by: ____________________________________________________

Microchip #___________________________

Microchip company: __________________________________________

If not Spayed/Neutered:

Pre-adoption surger scheduled for: (date) ____________________________

Veterinarian/Clinic: ______________________________________________

Adopter Picking up pet on: (date) __________________________________

ADOPTION COUNSELOR CHECKLIST