Dog Adoption Application

DOG ADOPTION APPLICATION

Thank you for visiting the Olympic Peninsula Humane Society.  This questionnaire will help us to help you select the right pet for your particular lifestyle. Adoption fee includes first vaccination, surgical sterilization, free health examination certificate, rabies vaccination and a microchip with local and national registration.

At the time of adoption you will be issued a free health examination certificate good at many veterinary offices on the North Olympic Peninsula.

Please use this certificate within 3 business days of your adoption.  If the animal is determined to be ill by the veterinarian during this period, you may return him or her to the shelter for a full refund.  Failure to use this is certificate could result in forfeiture of the opportunity for refund. You may choose to treat any illness found; however, OPHS will not be responsible for any veterinary charges.

Applications are kept on file for 60 days.

Name:__________________________________________

Phone#: Home ______________Cell ______________

Physical Address:_______________________________________________________________                                   Street            City                 State                           Zip

Do you live in a: 0 House 0Apartment 0 Mobile Home  0Condo 0 Duplex  0 With Parent/Relative   Other____________________________

2. Do you: 0 OWN  0 RENT      

3. Landlord Name:_____________________________________  Phone:_______________________________

4. How long have you lived at your current residence?____ Do you plan on moving within the next 6 months?_____

5. If you move in the future what will you do with your pet(s)?___________________________________________

6. How many adults live in the home? _______ How many children? _______ Children’s ages: ________________

7.  Who will be responsible for the dog? ________________________________________________________

8. Why are you adopting this pet? Check all that apply.  0My companionship 0Family companionship     0Gift      0Watch Dog     0 Hunting     0Breeding  Other?__________________________________________

9. Have you adopted an animal from us before? _____

When? ____________________Do you still have the animal?_______

If not, what happened to the animal?____________________________________________________________

10. Do you have a fenced yard?  ________

What type of fencing?___________________________________

If you do not have a fenced yard, would you be willing to put up a fence or build a pen to contain your dog? _____

11. Where will the dog live?  0 strictly inside   0 strictly outside  0 both inside and outside

12. Where will the dog sleep at night?        0 inside     0 outside

13. How many hours a day will he dog be left alone?______________

14. Where would the animal stay when you are not home? Check all that apply.              0 loose inside  0 confined inside 0 loose outside  0Kennel/run/fenced area outside  0tied or chained outside

15. Describe your home’s activity level?  0 busy, active, noisy  0 moderate coming and going   0 quiet

16. How will you train and exercise this dog? ________________________________________________________

17. Would you spay or neuter this dog?_________________ Why?_______________________________________

18. Are you aware that it costs on average $300 – $800 a year to own a dog?  _______________________________

19. Have you ever surrendered a pet to an animal shelter?______  When?________ Why?_____________________

20. How much time will you allow your new dog to adjust to your present pets and/or new home?_________________________________________________________________________________________________

21. What problems would cause you to return an animal? Check all that apply.              0 barking      0 chewing     0 house training      0 shyness/other fears     0 scratching/climbing on furniture  Other: Please describe:____________________________________________________________________

22. Would you be committed to work with the dog to correct any of these and most other problems?____________

23. What pets do you currently have in your household?

Type            Spayed/Neutered        Kept Where                How Long owned?          Age

#1  dog  cat         yes  no              inside  outside              _______________

#2  dog  cat         yes  no              inside  outside              _______________

#3  dog  cat         yes  no              inside  outside              _______________

#4  dog  cat         yes  no              inside  outside              _______________

#5  dog  cat         yes  no              inside  outside              _______________

 Other:_________________________________________________________________________________________           24. Do you have a veterinarian?   0Yes  0No   Clinic Name:_______________________

25. May we contact your veterinarian?  0Yes  0No

26. Are you willing to provide a lifetime home for this pet, medical treatment and specialized obedience training?      0Yes  0No   If not, why?_____________________________

27. Individuals who adopt an Olympic Peninsula Humane Society animal may be contacted periodically for an update to help ensure that the animal successfully adjusts to its new life.  If you adopt an OPHS animal, do you consent to home visits before and/or after adopting this pet? ___________________________

**  I certify that the above information is accurate to the best of my knowledge and understand that falsification of information can be cause for denial of my application or future forfeiture of the adopted pet.

**  Shelter staff reserves the right to deny adoption applications for any reason that does not comply with the philosophy of our organization.

_______________________________________________   __________________________ Signature of Applicant                    Date