Name of dog applicant is applying for:
Name
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First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone | Home
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(###)
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Phone | Work
(###)
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Phone | Cell
(###)
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Email
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Are you:
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Living Arrangement
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*If "other", where?
Do you:
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If renting, please provide Landlord name and phone number:
How long have you lived at this address?
*
Do you anticipate moving in the future?
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Do you anticipate traveling in the future?
*
Number of adults and ages:
Number of children and ages:
Are you aware it is your responsibility to educate your children and household members the humane and correct treatment/handling of animals?
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Do any members of the family have allergies that may be aggravated by the addition of this dog?
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Who will mainly be responsible for the care of this dog?
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How many pets have you owned in the past 5 years?
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Name, species, breed, age and sex:
Please add if they are good with other animals
Where did he/she stay during the day?
Where did he/she stay during the night?
Spayed/Neutered?
Last Vaccination Date:
MM
DD
YYYY
Is he/she still with you? - If yes, tell us a little bit about them. If they have passed on, please let us know what happened.
Name, species, breed, age and sex:
Please add if they are good with other animals
Where did he/she stay during the day?
Where did he/she stay during the night?
Spayed/Neutered?
Last Vaccination Date:
MM
DD
YYYY
Is he/she still with you? - If yes, tell us a little bit about them. If they have passed on, please let us know what happened.
Name, species, breed, age and sex:
Please add if they are good with other animals
Where did he/she stay during the day?
Where did he/she stay during the night?
Spayed/Neutered?
Last Vaccination date:
MM
DD
YYYY
Is he/she still with you? - If yes, tell us a little bit about them. If they have passed on, please let us know what happened.
Veterinarian Name:
Veterinarian Number:
(###)
###
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Are you willing to accept the financial responsibility of owning a dog and all unexpected/required medical expenses (around $800-$3000 per year)?
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i.e. food, shelter, yearly vaccinations and vet exams, parasite prevention/treatment, and insurance
What are your plans if a pet becomes sick or injured?
What is your yearly budget for your pet(s)?
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Do you have or are planning to purchase pet insurance?
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How do you plan to correct unwanted behaviors? (ie. chewing shoes, digging up garden, barking for no reason, etc.)
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What training method(s) do you plan to use?
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What training method(s) have you used in the past?
Have you ever potty trained/house broke an animal? If not, how do you plan to?
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How do you plan to introduce your new pet to the others in the home?
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If your new dog does not get along with another dog in your home (after meet-and-greets), what will you do?
If you have any dogs now, do they have any behavioral issues?
Are you prepared to allow an adjustment period of at least one month?
Are you willing to work through any issues your new pet may have/develop?
How long and how often will the dog be left alone? Where will he/she be kept when you are not home?
What activities do you plan on doing with your dog?
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i.e. hiking, swimming, running, walking, cuddling
If you have to move what do you plan to do with you pet?
If you go on vacation what do you plan to do with your pet?
If your pet outlives you, have you made arrangements to where your pet(s) will live their life(s) out?
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Do you have a fully or partially fenced in yard?
Do you have any of the following:
Check all that apply
Have you or any member of the household been charged with Animal Cruelty?
Have you ever had to surrender a pet? If yes what were the circumstances?
Have you ever adopted or tried to adopt from a shelter, rescue, or different organization?
*
If yes and were denied, please explain where and why.
Where will the dog be kept during the day?
Where will the dog be kept during the night?
How often will the dog be walked and let outside?
Do you have any questions/concerns about the animal(s) you are interested in adopting?
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How long have you been considering adopting a new pet?
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Most importantly, why do you wish to adopt this dog?
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Reference 1 Name:
*
First Name
Last Name
Reference 1 Phone number:
*
(###)
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Reference 1 email:
Reference 2 Name:
*
First Name
Last Name
Reference 2 Phone Number:
*
(###)
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Reference 2 email:
Reference 3 Name:
First Name
Last Name
Reference 3 Phone Number:
(###)
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Reference 3 email:
I agree to the following:
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I understand that any information given will be held confidential.
If under any circumstances I am unable to keep this animal, I agree to return him/her directly back to the shelter. I understand no adoption fees will be refunded, and I may be charged a surrender fee.
The pet will not be abused, neglected, or mistreated in any manner and will not receive any cruel or inhumane forms of punishment.
The pet will not be chained, roped or otherwise tethered at any time.
The pet will not be caged/kenneled needlessly or for long periods of time.
The pet will not be trained or used for attack/bait and will NEVER be used for animal fighting or other illegal practices.
By checking below I certify that the information I have given is true and that by any misrepresentation of facts may result in losing the privilege of adopting. I understand that the Carleton County Animal Shelter has the right to deny my request to adopt an animal and I authorize the investigation of all statements in this application.
Date of Agreement
MM
DD
YYYY
