Dog Adoption Application Form

Thank you for your interest in our rescue program and for considering adopting one of our dogs. We created the following questionnaire to assist in finding the appropriate dog for you. We ask for your understanding in that we are by no means questioning your integrity. It is our sole intent to ensure your satisfaction and our animal’s welfare. This questionnaire is the first step in our adoption process. Please review the entire Adoption Process so you will be aware of the various steps involved in adopting a rescue animal.

Please allow 24 to 48 hours for us to process your application. We appreciate your time and will contact you shortly.

Please fill out the form below to complete your adoption application:

Contact Information
What are you looking for?
Gender Preference:
Preference in Age:

Hair Length:

What are you looking for in a dog's personality?

Are you willing to work with a dog on housebreaking or obedience?
Pet-Owning Experience:

Are your pets spayed or neutered?
If not, why?
Are your current pets up to date on:
Heartworm testing/prevention?
Flea and tick prevention?
If you administer your own vaccinations, are you able to provide proof?
How many pets have you owned in the last 10 years?
If you no longer have these pets, what happened?
Your Household
Does anyone in your home have allergies?
Do You:
Type of dwelling:

Are there breed or weight restrictions where you live?
Time the dog will be home alone daily:
Will the dog live inside?
Is your yard fenced?

General Information
Have you ever adopted a pet from us?
Have you ever surrendered a pet to us?
Have you ever surrendered an animal?
If you have answered yes to any of these questions, please explain:
If necessary, due to sickness or injury, are you able to spend $500 or more on vet care?
What reasons would cause you to find a new home for your dog? (check all that apply)

How will you handle behavior problems or undesirable traits?
Do you have a plan for your dog should it outlive you?


  • You agree to obey your local laws regarding an animal, e.g. leash laws
  • You will return the dog to us if you are no longer able to keep it. You must not sell or give away the dog.
  • You are responsible for providing food, water, shelter, exercise, medical care and humane treatment at all times for the dog.
  • We reserve the right, in our sole discretion, to refuse any applicant for any reason.

By submitting this application, I acknowledge that all information on this application is true and correct. I understand that any misrepresentation of facts may result in refusal of adoption privileges to me. If any request for adoption is approved and it is later discovered that the above information is not true or correct, the Tuscarawas County Humane Society reserves the right to remove the adopted animal from my home.