Dog Adoptions

Submitted by admin on Tue, 03/20/2018 - 12:38

Dog's name you are interested in adopting *

Adopters Name *

Adopters date of birth *

Co-adopter's name

Co-adopter's date of birth

Address (where pet would be living) *

Phone Numbers *

Email address *

Place of business/employment *

Emergency contact and phone number *

Referred by: newspaper, website, vet clinic, friend, petfinder, walk in, other *

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

Yes

No

Do you have children/grandchildren at your home, or are you expecting a child in the near future? *

Yes

No

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: *

You answered "other" for dwelling, please explain.

Do you own or rent your home? *

Own

Rent

Landlords name and telephone number

How long have you lived at this address? *

What was your previous address?

Are you planning to move in the near future? *

Yes

No

Please elaborate on your moving plans

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

What kind of dog do you want? *

How long are you away from home daily? *

Is your yard fenced? *

Yes

No

How high is the fence and what type? *

How will you exercise your dog? *

Where and how will you let your dog to potty? *

Where will your dog be when...

When you are out of town or during an emergency *

When you are at work? *

At night? *

During the day? *

Who will mainly be responsible for this dog? *

Are you a first time dog owner? *

Yes

No

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 *

Describe other issues

If you currently have a dog(s) are they on heartworm preventative? *

Yes

No

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 housetraining and to assist in the transition period during the time your dog is learning their new routine? *

Yes

No

For what reasons would you surrender a pet to a rescue or shelter? *

Do you or anyone in your home have allergies? *

Yes

No

What kind of allergies?

For what reasons would you choose to euthanize a pet? *

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

Yes

No

Your veterinarians name, address and phone number *

Please list pets you currently have
Name	Type / Breed	Age	How long owned	Male/Female - Spayed Neutered	Stays indoors / outdoors
Name	Type / Breed	Age	How long owned	Male/Female - Spayed Neutered	Stays indoors / outdoors

List pets previously owned in the past 10 years
Name	Species / Breed	Years owned	Spayed or Neutered	Kept Indoors / Outdoors	Where is the pet now? if deceased cause of death.
Name	Species / Breed	Years owned	Spayed or Neutered	Kept Indoors / Outdoors	Where is the pet now? if deceased cause of death.

Thank you for taking time to fill out this application, which will help us to match you with right pet. There may be up to a week 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, I will pay a NON-REFUNDABLE 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 adoption a dog through ECHS.

I agree *

Yes

No

Leave this field blank