Dog Application Form

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Dog Adoption Application

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2

Have you asked all members of the household if they are in favor of adopting a dog?* This field is required

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3

Is anyone in the family allergic to dogs or pet dander?* This field is required

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4

Many times a new child changes how people react with their dog. If you are considering having children, have you thought about dog hair on the floor where the baby crawls or a toddler getting bit?* This field is required

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5

Do you own your own home? If you do not own your own home, do you have permission from your landlord to have a dog? What is your landlord's name, phone number, and policy on pets?* This field is required

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6

Has there ever been a dog with parvovirus on your property in the last ten years?* This field is required

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7

Have you thought about who will care for the dog when you are on vacation, out of town, or sick in the hospital, etc.?* This field is required

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8

Pets live 10-20 years, have you considered what you would do with your dog if you moved? Explain* This field is required

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9

What would you consider a good reason to give up a pet?* This field is required

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10

What is your home atmosphere like? Choose One* This field is required

Grand Central Station

Some Activity

Quiet and Peaceful

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11

Do you plan to give monthly heartworm preventative? Yes or No, Why or Why Not?

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12

Will the dog be inside or outside?* This field is required

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13

Where will the dog be kept during the day? What about at night? What about when left alone and for how long? ** This field is required

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14

Will there be a dog house if outside?* This field is required

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15

Do you have a fenced in yard?* This field is required

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16

Will you allow us to do a home visit if need be?* This field is required

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17

Do you understand that this dog/puppy is not guaranteed to be house trained?* This field is required

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18

Are you willing to work with the dog/puppy on any troubled behaviors such as house training issues, biting, or cooperation with other animals?* This field is required

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19

Are you committed to provide vet care for your dog such as check-ups, vaccinations (state law requires all pets over 6 months of age receive rabies vaccinations yearly), heartworm prevention, and flea/tick medicines?* This field is required

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20

How much do you think you will spend yearly for the care of your dog including vet care, heartworm prevention, flea/tick prevention, vaccines, food, toys, and bedding?* This field is required

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21

First and Last Name* This field is required

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22

Please List full address* This field is required

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23

Please list pets you have had in the past five years, but do not currently have and include: Name, Type of pet, Vet information (please provide vet name, vet number, and the person who the pet was under at the vet. What happened to the pet? How long ago?

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24

Phone Numbers (List Two)

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25

Email Address* This field is required

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26

What dog are you interested in?* This field is required

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27

How did you find out about this animal? Facebook, WRHS website, tv, newspaper, Petfinder, AdoptAPet, Shelter, Other

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28

Would you like to receive our newsletter?

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29

Please list all pets you currently have and include their: Name Type of pet Age If spayed or neutered Whether indoor, outdoor or both If declawed Vet Information (Please provide vet name, vet number, and the person who the pet is under at the vet)* This field is required

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30

Please read the following and sign below:* This field is requiredI have answered all of the questions honestly and completely, I am over 18 years of age and can provide proof of ID, and I understand that: Adopting a pet is a long-term commitment. WRHS reserves the right to refuse/reject my application at its discretion. Filling out this application does not automatically guarantee approval to adopt the animal nor does it require me to adopt the animal. I am giving permission to WRHS to contact my landlord and/or veterinarian that I have provided, and my signature allows release of any information necessary to process this application. Signing this form electronically authorizes an investigation of all information and statements on this form and certifies that all information is truthful and accurate. Please electronically sign full name and date with month, day, year, and time: *

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