Dog Adoption Application

Date *

Dog's name you are interested in adopting *

Adopter's Name *

Adopter's Date of birth *

Co-adopter's Name

Address *

Phone Numbers *

Email *

Place of business/employment

Emergency Contact and Phone Number

Referred by

Are all family members in approval of bringing a new dog into the family and committed to at least a two-week transition period?

Do you have children/grandchildren at your home, if so, what ages? Or are you expecting a child in the near future?

How many people live in your home? (Please list relation to you and ages)

What experience do the children in your home have around dogs?

Type of dwelling

How long have you lived at this address?

Do your own or rent your home?

lf you rent, provide your landlord's name and telephone number

Are you planning to move in the near future? Please elaborate

If you move or relocate, what will you do with the dog?

Do you want an inside dog, outside dog, or both?

How long are you away from home daily?

On average, how many hours a day will this dog be alone?

ls your yard fenced?

How high is the fence and what type?

How will you exercise the dog?

How and where will you let your dog out to potty?

Where will your dog be when you are out of town or during an emergency?

Where will your dog be when you are at work?

Where will your dog be at night?

Where will your dog be during the day?

Who will be mainly responsible for the care of this dog?

Are you a first time dog owner?

What do you think is a reasonable amount of time for a dog to adjust to a new home?

What attributes are you looking for in a companion? (energy level, size, height, level of training, skills, personality, etc)

Have you ever surrendered a dog to a shelter?

What issues would compel you to give up this dog?

Do you have your current dogs on heart worm preventative?

What methods will you use to train your new dog?

How do you plan to transition this new pet in with your current pets?

Do you own a crate to begin house training and to assist in the transition period?

Do you or anyone in your home have allergies? If so, what kind?

What reason would you choose to euthanize a pet?

Do you understand that ECHS has the right to deny an adoption for any reason they deem not to be in the best interest of the dog?

Your veterinarian's name, address, and phone number

Pets you currently have. Type/Breed, Age, How long owned, Male/female, Spayed/Neutered, Indoors/Outdoors

Pets owned in the last 10 years. Species/Breed, How long owned, Indoors/Outdoors, Spayed/Neutered, Where is the pet now? If deceased, cause of death?

Signature

Thank you for taking the time to fill out this application, which will help us to match you with the right pet. There may be up to a 1-2 day waiting period to process paperwork. Completion of this form does not guarantee that the Humane Society will place a pet in your care. ECHS is a charity depending solely on donations and service fees. I understand that if a dog is placed with me, t will pay a NONREFUNDABLE adoption fee.

I certify that the information I have provided is accurate and that any misrepresentation of facts may result in my losing the privilege of adopting a dog through ECHS.

By selecting submit, you do hereby electronically sign this document