Dog Adoption Application

Applicant’s Name

Primary Phone

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

Secondary Phone

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

Address

City

State

Zip Code

Email Address

example@example.com

Pet

Name of Animal You Are Interested In:

Ideal Dog – Sex

Ideal Dog – Age Range

Ideal Dog – Adult Size

Ideal Dog – Activity Level

Ideal Dog – Primary Location

If outside, please explain

An approved application and/or a scheduled visitation does NOT guarantee the animal will be placed in your home.

Applicant Initials

I certify that I am 18 years of age or over and that all of the information above is complete and accurate to the best of my ability. I understand that giving false information on this application will immediately disqualify me from the adoption process. I also understand that if I have failed to answer all of the questions or fail to sign this application, my application is subject to being declined. Finally I understand that the Johnson County Animal Shelter and its employees cannot attest to or guarantee the health of any animal adopted from this facility.

Applicant Signature

Application Date

Date

Hour MinutesAM/PM Option

Dog Adoption Application

Applicant Information

Current Pet Information

Ideal Dog Preferences

Acknowledgment & Signature