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.
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