DOG ADOPTION APPLICATION – Appalachian Highlands Humane Society

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Personal Information

Date *

Dogs name you are interested in adopting: *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Would you like to receive our Newsletter, Humanely Speaking and updates from the Appalachian Highlands Humane Society? *

Your age: *

*Must be 21 years of age or older to adopt.

Do you have a spouse or partner?

Spouse or Partner Name

First

Last

Your employer:

For whom are you adopting the dog?

Other than you, how many adults are in your home?

Are there any older people in your home?

Are there any children in your home?

If yes, what are their ages?

Do you have a fenced yard?

Type of home you live in:

Pet History

Have you had pets in the last 5 years?

Name of Pet Number 1: *

If no pets please enter NA

Type of pet:

Cat
Dog
Other

If other, please specify:

Species/Breed: *

If no pets please enter NA

Name of Pet Number 2: *

If no pets please enter NA

Type of pet:

Cat
Dog
Other

Species/Breed: *

If no pets please enter NA

If other, please specify:

Name of Pet Number 3: *

If no pets please enter NA

Type of pet:

Cat
Dog
Other

Species/Breed: *

If no pets please enter NA

List each vet/animal hospital where your animal(s) received care over the last 5 years. *

If no pets please enter NA

Name(s), Phone number with area code (for each) veterinarian. *

What owner name(s) are records listed under? *

Date of last vet visit: *

Name and Phone number of vet you will use for your new pet: *

Care and Upkeep Questions

Who will be responsible for feeding and taking the dog outside?

Who will take care of the dog in the absence of the primary caretaker?

Will you take to obedience training?

If you are applying for a puppy/dog that is not house trained, how will you house train the dog?

Have you considered the extra expenses that will come with having a dog including vet care, food, supplies and equipment, toys, training and boarding? Please explain:

Are you willing to take the time to house train a dog, and do you understand that changing a dog's environment may cause the dog to have accidents?

Are you willing to obtain an appropriately sized, open wire crate, if recommended?

If a behavioral problem arises, what steps will you take to work on it?

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

Does anyone in the home have any allergies to animals?

Describe the kinds of personal situations where you might have to return your adopted dog, i.e., job loss, children, move, marital change, etc.

How often will you exercise the dog and for approximately how long?

How many hours will the dog be left unattended (i.e., workday)?

When you are home, where will the dog be kept/sleep?

When no one is home (i.e. at work, shopping), where will the dog stay (be specific)?

How often do you travel?

What will you do with the dog when you travel?

Have you ever sold, given away or surrendered a pet?

How much time are you willing to give the dog to adjust to it's new environment and family?

Are you familiar with your local animal control laws (i.e. licensing, breed restrictions)?

Have all adult family members met with and agreed upon the dog?

A Little About You

Please tell us a little about yourself and why you feel you could provide a good home for a rescued companion animal?

Personal References

Name *

First

Last

Name Personal Reference Number One

Phone *

Reference Number One Phone

Name *

First

Last

Name Personal Reference Number Two

Phone *

Reference Number Two Phone

Signature *

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