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: * - Select -HouseApartmentMobile HomeCondo/TownhouseFarmDuplex/tripleOther 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? * - Select -Less than 1 Year1-5 YearsOver 5 Years 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? * - Select -Inside DogOutside DogBoth How long are you away from home daily? * - Select -Home all dayOut part timeAway 8+ hours/day 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 * What issues would compel you to give up this dog? * Chewing Soiling Barking Jumping Digging Shedding Property Damage None of the above Other 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 NameType / BreedAgeHow long ownedMale/Female - Spayed NeuteredStays indoors / outdoors Name Type / Breed Age How long owned Male/Female - Spayed Neutered SelectIndoorsOutdoors Stays indoors / outdoors Add a pet List pets previously owned in the past 10 years NameSpecies / BreedYears ownedSpayed or NeuteredKept Indoors / OutdoorsWhere is the pet now? if deceased cause of death. Name Species / Breed Years owned SelectYesNo Spayed or Neutered SelectIndoorsOutdoors Kept Indoors / Outdoors Where is the pet now? if deceased cause of death. Add a pet 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 Submit