The Humane Society of Charles County, Inc. 

                           Dog Adoption Application                       rev 04/04

 

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Please note that although adoption applications are considered in the order they are received, the pet is not automatically approved to the first request.  We try to match pets and people to find the placement that works best for everyone.  Additionally, we keep a list of people looking for certain types/breeds of animals and may call them before considering new requests for a particular animal.  All persons living in the household should be involved in choosing a pet.  The primary caretaker must approve the selection.

 

Animal’s Name ________________________________  Date_________________

 

Your Name: ________________________________ Co-Applicant’s Name:___________________________

 

Address:________________________________________ City:______________ State:_____ ZIP_________

 

Home #: _____________________ Work #: ________________________ Cell # _______________________

 

Length of time at this address:___________ Is it a house _____ townhouse _____ or apartment? ________

Do you own your home? ________ Rent?________ Military housing?________Live with parents?_______

If renting, name & phone # of landlord ___________________________________

 

Do you have a fenced yard? _________Fence height? __________Type of fencing?____________________

(A fenced yard is usually required; exceptions can be made dependent upon the animal & specific situation.)

 

Please tell us about your ideal dog (breed type or mix): __________________________________________

 

                    AGE                                            ADULT SIZE                         HAIR COAT 

            _____ 2 – 4 months                _____ 0 – 20 pounds (small)                          _____ short

            _____ 4-12 months                 _____ 20-50 pounds (medium)                       _____ medium           

            _____ 1-2 years                      _____ 50-100 pounds (large)             _____ long

            _____ 3-5 years                      _____ over 100 pounds (giant)                      _____ no preference

            _____ 5 years & older

_____ no preference

 

ACTIVITY LEVEL:

            CALM (i.e. will require daily walks and 30 minutes of exercise daily)

            SEMI-ACTIVE (i.e. will require daily walks/fetch or playing sessions/45-60 minutes of exercise daily)

            ACTIVE (i.e. will require daily mental & physical stimulation/60-90 minutes of exercise daily)

 

OTHER DESIRED QUALITIES:

q       Good with kids (now or in the future)        Good with dogs.       Good with cats.       Housebroken

q       Independent       Has had some obedience training       Other ___________________________________

 

What kinds of dog behavior do you find undesirable? ____________________________________________

How would you deal with these issues?  ________________________________________________________

 

What kinds of exercise/activities do you want to do with this dog?

     walks around the block              jogging daily           dog park visits             camping/hiking

    playing with other dogs          playing with kids         obedience classes         play fetch

    watch t.v.            agility or flyball           swimming         exercise off-leash         other ________________
PLEASE TELL US ABOUT YOUR HOUSEHOLD:

 

Dog Experience:       first time owner         have had one or two         knowledgeable & experienced

 

Home Atmosphere:       busy/grand central station        some activity        calm, low-key

 

What changes do you anticipate to your lifestyle within the next 5 to 10 years (check all that apply)

                   having children        moving         roommates changing        job transfer        

                   acquiring other pets           other _____________________________________________

 

What will happen to the dog if you have to move? _______________________________________________

 

Have you ever applied for or adopted an animal from this shelter?  Yes _______  No ________

If yes, when?_____________________  What was the outcome?____________________________________

 

Is anyone home during the day? ________ If yes, who? ___________________ When? ________________

How many adults live in your home?_______ Children?_________ Ages of children?__________________

 

Where will the animal be kept (inside, outside, chained, run line, crated, confined with a baby gate, free run of home)

During the day? _____________________________   At night?____________________________________

When you’re not home? ______________________   When you’re on vacation? ______________________

How many hours a day will the dog be alone?  __________________________________________________

 

Please list all of the animals you have owned or lived with (starting with the most recent or current):

Type & Breed of Animal

(eg: dog-Beagle,

cat-Persian)

Name of Pet
Age
Sex

Spayed or Neutered?

yes or no

When did you own this pet?

(eg:1990-1998)

Where is/was

the pet housed?

Do you still own this pet?  If no, what happened?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                      

 

 

 

 

 

 

 

 

 

What veterinarian/veterinary hospital sees & vaccinates your pets?  _______________________________

May we contact them? ______________  Phone number (if known) ________________________________

 

I certify that all the information is this application is true, and I understand that false information may void this application.  I understand that The Humane Society reserves the right to decline any adoption request.

 

Signature ______________________________________________ Date _____________________________

 

(for staff use only