FOR STAFF/RECEPTION USE ONLY       DOG Description of cat applying for: ID#_________-_______  Dog's Name: ________ Sex:_______Age:_______ Spay/Neutered:  Yes  No Spay/Neuter Voucher Provided:  Yes  No Heartworm test results:   n/a   negative   positive STAFF/RECEPTION ADOPTION OVERSEER INITIALs *__________ Date:_______________ PLEASE COMPLETE IN ITS ENTIRETY.

DOG ADOPTION APPLICATION (Please Print Clearly & Answer all Questions.)
The Hill Country Humane Society/SPCA has the right to refuse adoption to anyone.
Applicant's name_____________________________Driver's License #:____________
Local Address______________________________________________Apt#___________
City_________________________________State__________________Zip___________
Home Phone ________________Work Phone __________________ Email ___________

DESCRIPTION OF RESIDENCE: Do you Rent?______Own?_____
___House Property owner's name:____________________Phone____________
___Apartment How long have you lived here?______________________________
___Mobile-Home
___Duplex #Adults in house______#Children______Children's Ages_______

WHAT PETS DO YOU CURRENTLY HAVE IN YOUR HOUSEHOLD?
KIND        SPAY/NEUTER      KEPT WHERE?     TIME OWNED        AGE 
Dog__Cat__ | Yes___No___ | In____Out___ |_______________|__________|
Dog__Cat__ | Yes___No___ | In____Out___ |_______________|__________|
Dog__Cat__ | Yes___No___ | In____Out___ |_______________|__________|
Other_____ | Yes___No___ | In____Out___ |_______________|__________|

LIST PREVIOUS PETS
KIND       SPAY/NEUTER    KEPT WHERE?  TIME OWNED   WHAT HAPPENED TO PET 

Dog__Cat__| Yes___No___| In____Out___ |__________|_________________|
Dog__Cat__| Yes___No___| In____Out___ |__________|_________________|
________________________________________________________________________

·Are you at least 18 years old?______Yes_________No
·What is the name of your veterinarian?__________________________________
·Veterinarian's address__________________________________________________
·How long have you used this Vet? _______________________________________
·Who will be responsible for the daily care/feeding of this dog? _______________________________________
·Who will financially support this dog?__________________________________
·Reason for wanting this dog?____________________________________________
·Where will you keep this dog?___________________________________________
·Where will you keep this dog when you TRAVEL?___________________________
·Do all members of this household WANT this dog?_________________________
·If you have young children, they need to be educated on how to interact with the dog in order to prevent dog bites, are you able/willing to do that? ___Yes ___No
·How long will you give this dog to adjust to its new home?______________
·How many hours will your dog spend alone?_______________________________
·If you must give up this dog, what would you do with it?________________
·Would you object to a follow-up home visit by the Hill Country Humane Society/SPCA? Yes No Best day/time: ______________________________
·What amount of time will the dog be inside?______outside?______
·If adopting an outside dog, do you have a doghouse? ______Yes_____No
·If adopting an outside dog, do you have a fenced yard?_____Yes_____No
·If adopting an outside dog, do you have a shaded area?_____Yes_____No
·Do you realize that an outside dog may entertain itself by digging, chewing home items and/or escaping and wandering? ___Yes ___No

·What will you do if your dog shows destructive behavior? (Digging, chewing, jumping, tearing up plants/furniture or running off) ________________________________________________________________________________
·Do you realize that you will probably have to housetrain your new puppy/dog?
____Yes____No
·Would you like information on how to housetrain a new puppy or dog?
____Yes____No
·If adopting an adult dog, how many times per day will you exercise it? 1 2 3
·What form of exercise will you provide for your dog? _________________________

·What form of training will you provide your dog?
__Obedience class __Follow training books __Professional training __Home training

·Will you have your dog SPAYED OR NEUTERED within the recommended time frame? (A surgical operation to prevent parenthood for animals) ____Yes ____No
·Where/who will perform the surgery? _______________________________________________________
·What type of balanced nutrition do you intend to provide for your dog?
Dog Food Brand:_________________ Dry or Wet
·Will you have this dog vaccinated annually, by a veterinarian, against infectious disease?__________ Veterinarian:_________________________
·Are you familiar with heartworm disease?______Yes______No
·Will you maintain your dog on heartworm preventative?
_____Yes_____No
·Do you realize that dogs often live longer than 10 years and are you willing to assume responsibility for that long?______Yes_____No

·How will you keep the dog confined to your property? (Check all that apply)
___House____Kennel____Fence____Chain___Patio_____Garage___Leash____Other

·Where did you hear about the Christ-Yoder Animal Shelter/Adoption Center - Hill Country Humane Society/SPCA Adoption Program?
___Friend____TV___Newspaper___Relative___Radio___Billboard___Petfinder ___Internet ___Other
Have you applied to adopt from this shelter before today? ___Yes ___No
Date:__________________ Pet Adopted? Yes No
If yes, where is this animal now? _______________________________________________


I certify the above is true and that false information may result in nullifying this adoption. The Hill Country Humane Society/SPCA has the right to refuse adoption to anyone. I understand that no animal can be held for me.

        Signature___________________________________Date___________________

Additional notes or comments:__________________________________________________________


Thanks again for supporting the Hill Country Humane Society.

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