Dog Adoption Application

Dog Name:
Date:
Name:
Phone:
Address:
Alt Phone:
City:
State:
Zip:
Email:
1. Do you rent or own it?
If rent, landlord name and number
2. Type of Home:
3. Are there children in the home?
If yes, please list ages
4. I would consider my household to be like:
5. Do you have a fenced yard?
a. If yes, type and height
b. If not, how will the dog be let outside?
6. Current Pets in the home: Pet One :
Pet Name One
Breed
Age
Indoor/ Outdoor
Pet Two :
Pet Name Two
Breed
Age Two
Indoor/ Outdoor
Pet Three :
Pet Name Three
Breed
Age
Indoor/ Outdoor
I certify that this information is true and accurate to the best of my knowledge. I understand the Washington County Johnson City Animal Sheter reserves the right to deny any application for any reason and that if I am unable to keep this animal for any reason, I will return it to the WCJC Animal Shelter so the animal can be re-homed.
Print Name
Signature:
Shelter Use Only
Date:
Application Approved
Application Not Approved
Reason
Reviewer Name
Signature:

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