Dog Adoption Application

Tuscola County Animal Shelter DOG Adoption Application
All adopting parties are required to complete this form prior to adoption. Tuscola County Animal Shelter reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions. Adoptions are not on a first come, first serve basis.
Applicant Information
Animal Name or ID # that you are interested in: *
Date*

MonthDayYear
Date
Name:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you 18 years or older?*

YesNo
Home Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:
Employer:*
Criminal History (Please include ALL offenses involving animals):*
Household Information
Who is living in your home?*

AdultsChildren over 5Children under 5
How many adults are in your household?*
Please list all members of your household (include their relation to you, names, ages):*
How many children are in your household?*
Have your children been around animals before?*

YesNoNA
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:
Does your landlord allow dogs?

YesNo
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Do you have a fully fenced yard?*

YesNo
Height and type of fence
Do you have any of the following?

Underground fenceKennelDog Run
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
How many hours a day will you be home?*
Who are you adopting this pet for?*
What is your reason for adopting?*
Where will the animal you are wishing to adopt be kept during the day?*
Where will the animal you are wishing to adopt be kept at night? *
Current/Previous Pet Information
List any pets you own or have owned in the past five years. Please list their name, breed, age, and if they are deceased/living. *
How many of these pets are spayed/neutered?*
Have you adopted from an animal welfare group before?*

YesNo
If yes, what group?
Have you ever given up a pet?*

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your CURRENT and/or PREVIOUS veterinarian or clinic. This information will be used in the application process. *
Do you agree to keep all of your animals fully vaccinated and up to date on vaccines by a licensed Veterinarian?*

YesNo
If you have any current dogs, are they up to date on their current Dog License for the County in which you live in? Please provide the license number, if so. If you do not have a dog, please type NA. *
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Can you afford regular vet care for this pet? Can you provide vet care for this animal if it were to need surgery, is ill, or there is an emergency?*

YesNo
Do you agree to have annual check ups and all vaccinations administered by a licensed veterinarian?*

YesNo
Have you ever house-broken a dog or puppy before?*

YesNo
If the dog has an "accident" in your home, what type of correction do you plan to use?*
How will you supervise the dog's outdoor activity?*
What length of time will you allow your new pet to adjust to his new home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
Do you plan to take an obedience class with your dog?*

YesNoNot sure
How often and what type of exercise do you plan on giving the pet?*
Reference Information
Please list 2 personal references (include name, phone number, and relation to you):
I understand that I assume full responsibility for the welfare of this pet from the date of adoption. I certify that all information on this application is true to the best of my knowledge.
Should be Empty:

Tuscola County Animal Shelter DOG Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information

Reference Information