How long have you lived at this address?
What are you looking for?
If you are interested in a specific dog, provide name:
If yes, what attracted you to this dog?
Size when grown (lbs)
Preference in Age:
Puppy Young Adult/Senior
Short Medium Long
What are you looking for in a dog's personality?
Active/Playful Mellow Good with Kids
Are you willing to work with a dog on housebreaking or obedience?
Yes No Pet-Owning Experience:
If you currently have other pets, please list names, types and ages
Veterinarian you currently use
Name the vet records are under:
Are your pets spayed or neutered?
If not, why?
Are your current pets up to date on:
Flea and tick prevention?
If no to any of the above, why not?
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?
Please list the names and ages of all individuals living with you
Does anyone in your home have allergies?
Type of dwelling:
House Condo Apartment
If you rent, Landlord's name:
Are there breed or weight restrictions where you live?
Time the dog will be home alone daily
Less than 8 hours More than 8 hours
Will the dog live inside?
Is your yard fenced?
Where will you keep the dog when no one is home?
If applicable please provide neighbor reference:
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?
How will you handle behavior problems or undesirable traits?
Do you have a plan for your dog should it outlive you?
Yes No Agreement:
You agree to obey your local laws regarding an animal, e.g. leash laws
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.