Dog Adoption Application

Animal you are interested in adopting

Applicant's First Name

Applicant's Last Name

Street Address

City

State

Apartment Number (if applicable)

Zip Code

Phone Number

Email Address

Alternate Phone Number

Date of Birth

Employer

Do you own or rent your home?

Please select your current residence type.

If you answered "other" above, please explain here:

If you rent, provide your landlord name and phone number

How long have you lived at this address?

Do you own other pets at the current time?

If yes, please list their names, breeds, and ages.

Are all of your pets spayed/neutered/fixed?

Are your pets current on their vaccinations?

Veterinarian's Name

Veterinarian's Address, City, State, and Zip Code

Veterinarian's Phone Number

Who will have primary responsibilty for the animal?

Including yourself, how many people live in your household?

Please list the ages & relationship of those who live in your home.

On average, how many hours per day will your pet be left alone?

Will this pet be predominantly living inside, outside, or both?

Please provide a description of this pet's living conditions.

Do you have a completely fenced-in yard? If so, what kind of fence?

If you answered "other" above, please explain:

If you do not have a fenced yard, how will you let the animal out?

Are there times when the animal will be tied/chained up?

Where will the animal sleep?

If you answered "other" above, please explain:

Have you ever turned your dog or cat into a shelter or given a pet away?

If yes, please explain?

I certify that his information is true and accurate to the best of my knowledge. I agree not to keep this dog on a chain. I understand that the Washington County Johnson City Animal Shelter 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 that they can rehome the dog. *