Contact Information
First Name
Required
Last Name
Required
Address
Home Phone
Required
Cell Phone
Email
Required
How long have you lived at this address?
Required
What are you looking for?
If you are interested in a specific dog, provide name:
If yes, what attracted you to this dog?
Size when grown (lbs)
Gender Preference:
Male Female
Preference in Age:
Puppy Young Adult/Senior
Hair Length:
Short Medium Long
What are you looking for in a dog's personality?
Active/Playful Mellow Good with Kids
Are you willing to work with a dog on housebreaking or obedience?
Yes No
Pet-Owning Experience:
If you currently have other pets, please list names, types and ages
Veterinarian you currently use
Vet's Phone
Name the vet records are under:
Are your pets spayed or neutered?
Yes No
If not, why?
Are your current pets up to date on:
Vaccinations?
Yes No
Heartworm testing/prevention?
Yes No
Flea and tick prevention?
Yes No
If no to any of the above, why not?
If you administer your own vaccinations, are you able to provide proof?
Yes No
How many pets have you owned in the last 10 years?
If you no longer have these pets, what happened?
Your Household
Please list the names and ages of all individuals living with you
Does anyone in your home have allergies?
Yes No
Do You:
Own Rent
Type of dwelling:
House Condo Apartment
If you rent, Landlord's name:
Landlord's Phone
Are there breed or weight restrictions where you live?
Yes No
Time the dog will be home alone daily
Less than 8 hours More than 8 hours
Will the dog live inside?
Yes No
Is your yard fenced?
Yes No
Where will you keep the dog when no one is home?
If applicable please provide neighbor reference:
General Information
Have you ever adopted a pet from us?
Yes No
Have you ever surrendered a pet to us?
Yes No
Have you ever surrendered an animal?
Yes No
If you have answered yes to any of these questions, please explain:
If necessary, due to sickness or injury, are you able to spend $500 or more on vet care?
Yes No
How will you handle behavior problems or undesirable traits?
Do you have a plan for your dog should it outlive you?
Yes No
Agreement:
You agree to obey your local laws regarding an animal, e.g. leash laws
You will return the dog to us if you are no longer able to keep it. You must not sell or give away the dog.
You are responsible for providing food, water, shelter, exercise, medical care and humane treatment at all times for the dog.
We reserve the right, in our sole discretion, to refuse any applicant for any reason.
By submitting this application, I acknowledge that all information on this application is true and correct. I understand that any misrepresentation of facts may result in refusal of adoption privileges to me. If any request for adoption is approved and it is later discovered that the above information is not true or correct, the Tuscarawas County Humane Society reserves the right to remove the adopted animal from my home.
