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Adoption Application
Adoption Application
This is the form used for Adoption Applicants.
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
DOB
*
Drivers License #
*
Employer
*
Income Estimate
Are you financially able to care for a pet? (This includes, vet visits, grooming, feeding, etc.)
*
Yes
No
What pet are you applying to adopt?
*
Dog
Cat
Name and breed of pet interested in {First and second choice}
*
Are you renting your residents
*
Yes
No
Housing Type
*
Apartment
Mobile
Home
Other
If other, please specify
Landlord's Name
First
Last
Landlord Phone Number
Number of people living in home
*
Number of Children in Home.
*
How many hours will the pet be left alone?
*
Someone is home at all times
1-3
4-7
8-10
11-13
14+
Is everyone in the home in agreement on adopting a pet?
*
Yes
No
Haven't discussed it yet
Have you ever adopted a pet before?
*
Yes
No
From where?
Have your animals been spayed/neutered?
*
Yes
No
I don't have any other pets
Are you a Belmont County resident and own a dog?
*
Yes
No
Do you currently own or reside with any pets? Please list breeds, ages, sex, and how long you have owned each.
Please list dog license numbers (seperate # by commas)
Have you ever surrendered a pet to a shelter or humane organization?
*
Yes
No
If Yes, Please explain
How will the pet be exercised?
*
Cable or chain tie out
Walked on leash
Fenced yard
Allowed to roam
Will the pet live indoors, outdoors or a combination of both?
Only Inside
Mostly Inside
Only Outside
Mostly Outside
Both Equally
Dog Door, It can come or go freely
How will the pet be kept safe and secure in your yard?
*
Cable or chain tie out
Cable runner
Kennel
Underground dog fence
Fenced yard
We don't confine our dogs to our yard
What type of fence and how high?
Who is your Veterinarian?
*
Vets Phone
*
Under what name are records listed?
*
First
Last
At minimum it can take 2 weeks for the pet to adjust to its new environment. Do you have the time to spend?
*
Yes
No
Our animals are alone for about 15 hours a day which means many are not crate or house trained. Do you have the time to put the dog on a schedule? This could take at least 2 weeks.
*
Yes
No
Many times our animals come to us with unknown backgrounds. Do you understand that the pet may act differently when home than it would at the shelter? Do you understand that dogs need leadership and mental stimulation to be happy?
*
Yes
No
Anything you would like us to know
Please list 2 references that we can contact.
Name
*
First
Last
Phone
*
Name
*
First
Last
Phone
*
Consent
*
I agree
I certify that the above facts are true to the best of my knowledge and belief and I understand that I subject myself to disciplinary action in the event that the above facts are found to be falsified.
Check this box and sign below if this is true.
Signature
*
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