Dog Adoption Application

Dog you are interested in adopting. If name does not appear, it means they are not available for adoption. If several dogs are of interest, please select the dog you most prefer. *

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 *

How did you find out about us? *

Are you a volunteer, staff, or professional associate of the HSNWGA? *

Have you applied anywhere else for a pet? *

If yes, where else have you applied for a pet? *

Have you adopted from the HSNWGA before? *

If yes, please share the name of the dog you adopted (kennel name) and the adoption date.

Is this pet for you or someone else? *

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? *

How many pets have you owned in the last 5-10 years? *

What happened to them?

Are your pets current on their vaccinations? *

Have you ever turned your dog or cat into a shelter? *

If yes, please explain? *

Veterinarian's Name (If you have never owned a pet, please tell us where you would go)

Veterinarian's Phone Number

Have you ever had a pet euthanized? *

If yes, please explain: *

How do you feel about having pets spayed/neutered? *

Are you familiar with heartworm and heartworm prevention? *

If you have pets, will they adjust to a new pet in the house? *

Please check the main reason you plan to adopt a pet: *

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

Please describe in detail the pet you are looking for.

Do you own or rent your home? *

Please select your current residence type. *

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

How long have you lived at this address? *

If you rent, does your landlord and lease allow pets? *

Landlord Name & Phone Number *

Including yourself, how many people live in your household? *

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

Is everyone in your household aware that you are planning to adopt a pet? *

Does anyone in your household have allergies to dogs/cats? *

Employment Status *

If you chose "other" above, please explain: *

If you are employed, what is your current occupation?

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

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

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