Name*:    

Home Phone*:    Cell Phone:  

Dog or Puppy applying for by name:

Dog or Puppy applying for by P or D #:

Address*:   Apt.#  

City*:  State*: AK AL AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip Code*:  

Employer: Work Phone:  

Email Address:   Best number to call you weekdays? Home Work Cell

The Humane Society:

How did you hear about us? Friend Web Newspaper Humane Society Drive-By Other If Other chosen, please explain:

Would you like to find out more about volunteering, fostering, or socializing animals? Yes  No

Have you ever had to turn an animal into a shelter before? Yes  No

Have you ever applied to adopt an animal from the Humane Society of Forsyth County?* (Must choose one)Yes  No

Have you ever adopted an animal from the Humane Society of Forsyth County?* (Must choose one)Yes  No 

If yes, who did you adopt?

Would you agree to a home visit from a Humane Society Volunteer as a condition of adoption?*(Must choose one)  Yes  No

What's this about a home inspection

Your New Dog or Puppy:

Why do you want a dog?*   Family Pet Gift Guard Dog Other If Other chosen, please explain:

Will it be indoors, outdoors, or both?*  Indoors Outdoors Both Where will he or she sleep?*

What percentage of time will the dog spend outside?*   Inside?* 

Who will be the primary adult responsible for training?*

Are all your current pets up to date on vaccines? Yes No Some Are Does Not Apply, this is a gift Does Not Apply, this is my first animal Do Not Know

On Heartworm Preventative? Yes No Some Are Does Not Apply, this is a gift Does Not Apply, this is my first animal Do Not Know If so, what kind?    

On Flea Preventative?           Yes No Some Are Does Not Apply, this is a gift Does Not Apply, this is my first animal Do Not Know If so, what kind?

Please list all pets your family has owned in the past 5 years, including where they are now, Doctor that animal was seen by including Vet's phone number.

Do you give Humane Society of Forsyth County permission to contact vet? *

Pet 1: No other animals Cat Dog Bird Other Where are they now?   Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other If other, please explain:

Veterinarian Clinic/Doctor: Contact Information - phone:

Pet 2: No other animals Cat Dog Bird Other Where are they now?  Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other If other, please explain:

Veterinarian Clinic/Doctor: Contact Information - phone:

Pet 3: No other animals Cat Dog Bird Other Where are they now?  Does not apply Still in current household Returned to original owner/shelter Deceased Ran Away Stolen Other If other, please explain:

Veterinarian Clinic/Doctor: Contact Information - phone:

More than 3? Yes  No  If yes, you can provide Humane Society of Forsyth County (HSFC) more details later.

How much would you expect to spend yearly on routine vet visits, health care, and food for this pet?* $

(Expenditures include, annual vet checks and shots, healthy food, dental care, heartworm and flea preventative.)

Are you willing and able to make a commitment to do this routine vet/health care including heartworm and flea preventative every year?* Yes No Not Sure

Do you agree, for the pets safety, to keep an ID tag on this animal at all times?* Yes No Not Sure The HSFC has provided one for each animal, or you may choose to purchase one with your information.

*If Outdoors: Is your yard fenced? Yes  No   If No, please explain how you will contain your new pet:

Do you have a pen or tie out? None Pen Tie Out

What accommodations can you make for weather extremes?

How often will you check food and water?*

*If Indoors: Is your yard fenced? Yes  No   If No, how will he/she be taken out?

Have you ever housebroken a dog? Yes  No  Have you owned or lived with an indoor dog before? Yes  No

Have you ever "Crate Trained"? Yes  No   How many hours will the dog need to crated each workday?

Your Home and Family:

How many people in your home?*  Do you have children in the home?*(Please choose one) Yes No On the way 

If Yes, what ages?  Months Year(s) Months Year(s) Months Year(s) Months Year(s)   Months Year(s) Months Year(s)

Are the children experienced with dogs?*(Must choose one)Yes  No  Does Not Apply  

Is an adult home during the day?*(Please choose one)Yes  No   

Do you rent or own home? *  Own Rent If you rent, are you allowed pets? Yes  No   Weight Limit?    pounds    Pet Deposit? $

How long have you lived at your current address?* Years Months   Do you plan to move in the next 12 months?*(Must choose one)Yes  No

Do you agree to return your pet to HSFC if your conditions change and you are no longer able to care for your dog? Yes, I agree  OR No, I disagree *

Are you willing to accept this pet as a part of the family, and give it a kind and loving home?   Yes, I agree OR No, I disagree*

Are you at least 21 years of age?  Yes, I agree OR No, I disagree *  Date of birth? 

  I,   hereby certify that all the information above is true and correct and authorize HSFC to verify any and all information provided for purposes of adoption. I also understand that any untruthfulness will automatically cause my application to be declined.*

  After pressing the Submit button, just once, wait a few moments, you will get a confirmation page     

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