Dog Application

The Hancock County Animal Shelter is located in Hancock County, WV. *

I acknowledge that you are located in Hancock County, WV.

First Name: *

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Email: *

Confirm email

DL/ID Number

Date Of Birth *

Who are you adopting this dog for? *

Myself
Someone Else

If you selected "Someone Else" above, who are you adopting this dog for? *

Please list names and ages (Jane Doe/25 yrs.) of all person's living in the home. *

How busy is your family schedule? *

Very Busy
Busy
Not Busy

Does anyone in the home have allergies? *

Do you rent or own your property? *

Own
Rent
Land Contract

Do you agree to provide written agreement from your landlord to adopt a dog? *

Landlord's Name: *

Landlord's phone number: *

Where will your new dog be kept during the day? *

Where will your new dog be kept at night? *

Where will your new dog be kept while you're away? *

Please provide the name, address, and phone number of your primary care veterinarian. *

Do you agree to provide any and all veterinary treatment that your new dog may require throughout his/her lifetime? *

Are you aware of the need for heartworm prevention? *

Are you financially prepared to provide the care and commitment for a new dog? *

Are your current pets up to date on their Rabies vaccination? *

Yes
No
I don't have any current pets

Are your current pets spayed or neutered? *

Yes
No
I don't have any current pets

What will you do with your new dog if you move? *

Please list the name/age/sex/species/altered status of any pets you currently own: *

Do you have a fenced yard or dog run? *

Fenced Yard
Dog Run
I don't have a fenced in yard or dog run

Do you agree to a home visit if requested? *

What dog are you interested in adopting? *

Are you interested in any of our other dogs?

Have you ever surrendered an animal to our shelter or to any other shelter? *

How did you hear about us/this dog? *