Personal Information:

Date

First name

Last name

Animal of interest

Birthday

Physical Address

Town

State

Zip Code

Mailing Address (if different from physical)

Email

Cell phone

Home phone

Place of Employment /Job Title

Household Information:

Name of Spouse or Partner (if applicable)

Number of adults in your home

Number of children in your home

Ages of children in your home

Does anyone in your home have allergies? (If yes, please explain)

In what type of home do you reside?

Do you:

Name of Landlord/Homeowner (please type N/A if you own

Phone number or email of landlord/homeowner

How long have you lived at your current residence?

Please list the address of the last place you resided and for how long

Veterinarian Information:

You must contact your veterinarian for permission to speak with us for a vet reference. Please check box

Name and Phone number of your veterinarian

How many pets are currently living in your home?

Please list ALL current and past pets you have had within the last 5 years. Please include name, species, breed, gender, age and if they are still with you or not

Please indicate the type of dog you are looking for:

Specific breeds interested in

Specific breeds NOT interested in

Size / Weight desired

Age range desired

Why do you want this dog? (choose all that apply)

Gender

Male

Female

Open to gender

Where will this dog live?

Strictly indoor

Strictly outdoor

Other

When you are not home, where will this dog be?

I am open to (check all that apply):

During the day, how long will this dog be alone?

How will you confine this dog to your property:

Additional requirements (good with children, dogs, cats, etc):

___________________________________________________________________

Have you ever given a pet away to another person or animal shelter?

Yes

No

If yes, please explain:

Have you considered what you would do with this dog if you had to move? What would that be?

Have you considered what you would do with this dog if you couldn't take care of it due to personal injury, illness or death? Do you have someone who will take your pet? Have you discussed this with this?

Please list TWO personal references that are not family or spouse (please include phone or email)

I certify that the above information, along with any other information I have given either verbally or in writing is correct to the best of my knowledge. I further realize that any false statements can result in my application being denied. The SHS has the right to deny any adoption/applicant for any reason, without giving cause.

Personal Information:

Household Information:

Veterinarian Information:

Please indicate the type of dog you are looking for:

Dog Adoption Application

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