Dog Adoption Form

A completed adoption application MUST be submitted.
We reserve the right to refuse any adoption at our discretion.
A veterinarian reference MUST be provided and will be verified by us.
For the health and safety of all pets involved, all current pets in the household MUST be up to date on all routine vaccinations and spayed or neutered BEFORE the newly adopted pet arrives. This will be verified during the veterinarian reference.
All adoptions are on a case-by-case basis depending on the needs of the pet being adopted. As a Humane Society, we hope that you understand and appreciate that we will always put the safety and well being of our pets first and foremost. Our goal is to place our pets into a home where they will always be provided with humane treatment.

Note: False information on this application could result in the forfeiture of adoption fee and animal adopted. We reserve the right to refuse any applicant.

Dog you wish to adopt:*
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Name of Spouse or Roomate
First Last
Home/Cell Phone*
Work Phone*
Email*
Place of Employment*
Work Address*
Street Address Address Line 2 City State ZIP Code
Emergency Contact*
Name Phone
What is your reason for wanting to adopt this dog?*

(i.e. family pet, child's pet, watch dog, hunting dog, companion, companion for other pet, etc.)
Is your residence a:*
If you rent, please provide your landlord's name and number:
How many people live in your household? Please provide the number of adults, number of children, and the age of any children:*
How many pets have you owned in the past five years? Please list what kind of animal, and their current condition.*
(Still with you, died of natural causes, put to sleep, sold, ran away, given away, etc.)
Have you ever had a pet that was struck and/or killed by a vehicle?*
If you currently own pet(s), please list type, breed, and age of each:
Your veterinarian's name and phone number:*
Are all your current pets (if any) spayed/neutered? If not, why?*
Are your current pets' (if any) vaccinations up to date?*
Do you know how to protect your dog from heartworms?*
Do you think it's important to take your dog to the vet for full preventative and medical care at least once a year?*
What do you expect annual pet care (vet care, medication, vaccines, food, etc.) to cost?*
If this dog develops a serious medical condition that becomes expensive, what would you do?*
Who will be responsible for the daily care of this dog?*
Where do your current pets (if any) stay when home alone?*
What provisions are made for a pet when you are on vacation?*
Is there a yard available where this dog will reside? If so, is it fully fenced without gaps? What is the height of that fence? Is there a doghouse or shelter in the yard?*
Do you have a swimming pool?*
Where will this dog stay?*
How many times a week do you anticipate walking the dog on a leash?*
How much time will this dog spend alone each day?*
Where will this dog sleep?*
What plans do you have for obedience training?*

Classes, video, books, in-home lessons, none, other)
Have you ever had a serious behavioral problem with a pet? If yes, please explain:
How would you resolve behavioral problems that may appear with this dog?*
If necessary, what procedures will you use for housebreaking this dog?*

(crate training, newspaper, rubbing nose, swatting with newspaper, outside only, other)
Would you allow UCHS to visit your home to verify where this dog will be kept?*
Phone
This field is for validation purposes and should be left unchanged.

Union County Humane Society

Dog Adoption Form

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Union County Humane Society