Dog Adoption Application

Applicant must be 21 to adopt.

Home At Last Humane Society reserves the right to refuse adoption to anyone who fails to comply with their policies. Failure to provide correct information may warrant adoption denial. I hereby give permission to Home At Last Humane Society to contact my veterinarian to obtain information about past and present pets. I also authorize Home At Last Humane Society to verify the below listed information:

Application Date *

What dog are you interested in?

Applicant Name *

First Name

Last Name

Co-Applicant Name
First Name

Last Name

Driver's License Number

Email *

Phone *

Alternate Phone *

Applicant Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (If Different)

Address Line 1

Address Line 2

City

State

Zip Code

How Long have you lived at this address? *

Any plans to move in the near future? *

Do you rent or own your home? *

If you rent, do you have landlord permission to have an animal and have you paid all pet deposits? *

If you rent please supply Landlord Name, Address and Phone number

How many people live in your household? *

Do all the adults in the household know you plan to adopt? *

Are there children in the household? *

What are the ages of the children? (If Not applicable Write N/A) *

Does anyone living in your household have any known allergy to animals? *

If Yes, To what kind of animals? (If Not applicable Write N/A) *

Why do you want to adopt a pet? *
Companion for selfCompanion for childGiftCompanion for another petCompanion for another household memberGuard/Protection

Is this your first pet? *

Do you currently have pets? *

Please list your presently owned pets, if any (Name, Breed, age, gender, Spay/Neutered?): (If Not applicable Write N/A) *

Have you ever given away or relinquished an animal? *

Please list any pets you have lost, given away, or disposed of in the last 2 years: (If Not applicable Write N/A) *

Veterinarian/Clinic Name (If None Write None) *

Veterinarian Phone Number *

It takes time for animals to adjust to a new environment. Are you prepared to allow the time needed for your new pet to adjust to your home?

Are you committed to providing a responsible home for your pet’s entire life (10+ years)? *

If you have to move, what do you plan to do with your pet(s)? *

Who in the household will be the pets’ primary care giver?

Where will the pet be kept during the day?

Where will the pet be kept dat night?

Please note that Home At Last Humane Society does not adopt to outside only homes. Your new dog should be part of the family and therefore able to be inside the house.

Do you have a fenced yard? *

If no, how do you plan on containing your pet outside of your house? *

How many hours per day will your pet be left alone? *

What training techniques would you use if your pet: (Please be specific):

Digging: *

Barking: *

Chewing: *

Separation Anxiety: *

Aggression: *

How do you plan to house train your pet? *

Failure to house train: *

Personal References

Please give TWO references other than your veterinarian, please include phone number/address. *

Second reference *

Please understand that Home At Last Humane Society is not a veterinary clinic and that this animal may be harboring a medical condition which is not apparent during its stay at the shelter. Should such a condition become apparent after adoption, you assume full responsibility for any related veterinary care. We strongly recommend that you take advantage of the free office visit included in the adoption, within two (2) weeks of adoption. By clicking the submit button below, you have stated that all information on this application is true to the best of your knowledge. Home At Last Humane Society has the right to refuse an adoption if it is found that information stated on the application has been falsified. Once approved you will have the one time option to put the animal "on hold" for 24 hours for a $25 fee. This gives you the chance to come meet the animal and so no one else can adopt the animal in the meantime. The $25 fee for the hold is nonrefundable but will go towards your adoption should you adopt.

Signature (Use you mouse to sign your name)

Type Name