Dog Application Form

Dog Adoption Application
Thank you for your interest in adopting from WRHS! Please complete this application truthfully. Adoption applications are designed to help us determine if the adoption is in the best interest of the animal and to assist the potential adopter in finding an animal most compatible with his/her lifestyle. We sincerely hope we can be of service to you.
First and Last Name*
What dog are you interested in?*
Please List full address*
Phone Numbers (List Two)
Email Address*
Please list the first and last name of all adults that reside at this address. *
Have you asked all members of the household if they are in favor of adopting a dog?*
Is anyone in the family allergic to dogs or pet dander?*
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?*
Are there kids in the home? If so what ages?
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?*
Has there ever been a dog with parvovirus on your property in the last ten years?*
Have you thought about who will care for the dog when you are on vacation, out of town, or sick in the hospital, etc.?*
Pets live 10-20 years, have you considered what you would do with your dog if you moved? Explain*
What would you consider a good reason to give up a pet?*
What is your home atmosphere like?*
Do you plan to give monthly heartworm preventative? Yes or No, Why or Why Not?
Will the dog be inside or outside?*
Where will the dog be kept during the day? What about at night? What about when left alone and for how long? **
Will there be a dog house if outside?*
Do you have a fenced in yard?*
Will you allow us to do a home visit if need be?*
Do you understand that this dog/puppy is not guaranteed to be house trained?*
Are you willing to work with the dog/puppy on any troubled behaviors such as house training issues, biting, or cooperation with other animals?*
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?*
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?*
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? *
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)*
I understand that applying to adopt an animal does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the cancellation of adoption from White River Humane Society. I certify that the above information is correct, and I understand that the information will be verified. I 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:
Electronic Signature*
Full name | Month/Day/Year | Time
Should be Empty: