DOG ADOPTION APPLICATION

DOG ADOPTION APPLICATION
The Humane Society of Ottawa County

2424 E. Sand Rd. Port Clinton. OH 43452

(419)734-5191

HSOCpets@gmail.com

www.HumaneSocietyOfOttawaCounty.org
Name of dog(s) you are interested in adopting
Personal Information
Name*

First NameLast Name
Address*

Address

Street Address Line 2

City. State, ZipState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Do You Have Children?*
If yes, what are their ages?
Why did you decide to adopt a dog?
What characteristics are you looking for in a dog?
What circumstances would make you give up your dog?*
Housing Information
How long have you lived at your current address?*
Do you rent or own?*
If renting, do you have permission from your landlord to adopt a dog?
If renting, are you aware of any pet deposits/monthly fees?
Landlord Name

First NameLast Name
Landlord Phone
Do you have a fenced yard? (not a requirement)
Type of fence and height:
If you do not have a fence, are you prepared to walk your dog multiple times daily in spite of weather conditions?
Who will be primarily responsible for taking care of your dog?
Approximately how many hours per day will your dog be left alone?
Where will your dog stay when no one is home?
Where will your dog stay when you are home?
Where will your dog stay overnight?
What type of exercise will you provide for your dog?
How often?
Who will take care of your dog if you are out of town or unable? (vacation, illness, etc.)
How would you describe your lifestyle? (check all that apply)

Active/On the goQuiet/RelaxedEntertain oftenFrequent travel/Day TripsOther
Personal References

Please list 2 people not living with you that we may contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Years Acquainted*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Years Acquainted*
Veterinary Information
Current or most recent veterinarian:*
Phone Number
Please enter a valid phone number.
Do we have permission to contact your vet?*
Please sign here if yes

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Current and Previous Pet Information

Please provide the following info on CURRENT pets

	Name	Age	Species	Breed	Spayed/Neutered
Pet #1
Pet #2
Pet #3
Pet #4

Please provide the following info on PREVIOUS pets

	Name	Species	Reason Pet Is No Longer With You
Pet #1
Pet #2
Pet #3
Pet #4

Agreements For Adoption

Please initial each
I am prepared to make a commitment for the lifetime of my dog and am financially able to provide routine and emergency care. This includes, but is not limited to food, vet care, heartworm preventative, flea/tick control, boarding and training.
*
I will work with my veterinarian to form a regular schedule for wellness visits, inoculations and any tests necessary for the health and well-being of my dog. *
I will not chain or tie up my dog and leave him/her outside alone. My dog will be a companion, he/she will live inside of my home and be an important member of my family.*
If, for any reason I am unable or unwilling to keep my dog, I agree to return him/her to the HSOC. I will not give away or sell my dog. I will not surrender my dog to a different shelter or place with any other person without the express permission of the HSOC. *
I understand and agree that the HSOC makes no guarantee regarding my dog's temperament and is not liable for any future damages or injuries caused by my dog. *
I understand and agree that my dog is adopted "as is" with no guarantee whether implied or expressed. Any health condition unknown by the HSOC at time of adoption is not the responsibility of the HSOC. *
I give the HSOC permission to call/visit my home with reasonable notice to ensure my dog is being properly cared for. *
I agree to keep the HSOC informed of my current address and phone number. I agree to license my dog within 30 days of adoption in the county where I reside. *
I understand that the adoption fee is non-refundable after 2 weeks. If the adoption doesn't work out within 2 weeks I will return this dog to the HSOC upon which I will receive a full refund. If longer than 2 weeks is needed to decide the success of the adoption, I will call the HSOC to make those arrangements in a timely manner. *
Signature(s)*

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Date*

MonthDayYear
Date
Thank You For our Interest In Our Pets!

Adopt, Don't Shop!
Should be Empty:

DOG ADOPTION APPLICATION

Personal Information

Housing Information

Personal References

Veterinary Information

Current and Previous Pet Information

Agreements For Adoption

Thank You For our Interest In Our Pets!