Dog Adoption Application. Name of Dog Name * First Name Last Name Phone (###) ### #### Email Are you over 18? * Yes No Address * Address 1 Address 2 City State/Province Zip/Postal Code Country How long have you lived at your current address? * Resident Type * Apartment House Farm or Ranch Do you rent or own? Are animals allowed? Yes No Size and number of animals allowed (rent): Does your job require extensive travel? Yes No Have you ever owned a dog? Yes No Do you currently have any pets? What Breeds? Have your current pets been neutered or spayed? Yes No Are they up to date on their vaccines? Yes No Have you ever introduced a new pet into your home? How will you facilitate the new animal meeting your current ones? Are you adopting this dog for you or someone else? Are you aware of the life expectancy of your animal? Yes No Are you aware of the medical/housing/food costs associated with owning a dog? Yes No Are there any dog allergies in the home this dog will be in? Yes No Do you have any children in the household? What ages? Have the children been instructed on proper care of an animal? Yes No What do you know about this breed? Have you had any experience training a dog? Yes No Would you be willing to enroll your dog in obedience class? Yes No How will you discipline your dog? If you are adopting a puppy do you know how to housebreak an animal? Yes No Have you ever surrendered an animal of your own into an animal shelter before? Yes No If you have surrendered an animal, please explain why: Have you ever had to rehome an animal (to a new home other than a shelter) Yes No If yes, please explain why: For what reasons would you return this animal to us? Where will the animal be during the day? Indoors Outdoors Both Garage Barn Other What outside space is available? Fenced Yard Kennel Patio Unfenced Yard Approximate area of the yard/height of the fence: Do you have a pet door, if so where does it lead to? If an outside dog, what shelter do you have for it? How much time a day will your pet be alone? Where will your dog spend its time away from you? How will you exercise your dog? What will you do with the dog if you go on vacation? What arrangements will you make for the care of your pets in case of an emergency or if you become unable to care for them? Name and number of veterinarian: What is the most common reason you have visited the vet? Are you aware of the high cost of shots and regular veterinarian costs? Yes No Can you afford to pay for the veterinarian costs for the animals life time? Yes No If you move, what will you do with your pet? What will you do with your animal if for any other reason you can no longer care for it: Have you ever had an animal impounded or been issued a citation for an animal law violation? Yes No If yes, please explain why: I certify that the information given on this application is true and accurate to the best of my knowledge. I understand that providing any false information can be cause for denial of my application or future forfeiture of the adopted pet. By choosing to adopt, I understand that I am expected to make a considerate commitment of time and money to this animal for his/her lifetime, up to 20 years in some cases I understand that WHHS may make telephone inquiries to ensure the well-being of the animal I am adopting. If the dog is not already spayed/neutered there is an additional $150.00 spay/neuter deposit you will get back once you bring in a receipt proving he/she is fixed within the year of the contract. I understand the terms and conditions of this adoption and accept responsibility for its known and unknown health issues I, hereby release the Western Hills Humane Society from any and all liabilities pertaining to the adoption of the above-mentioned animal. Thank you!
