Adoption Application - Washington Area Humane Society

Applicant Information

Applicants First Name *

Applicant Last Name *

Email *

Email

Confirm Email

This will be used to register Microchip if adoption is approved. Type accurately.

Co-Applicant Full Name

Spouse, Boyfriend, Parent or person living with you and the cat.

Birth Date *

You must be 21 to adopt. A driver's license or ID is required to adopt.

Phone *

Please supply a phone number you can be reached at.

Address you and the dog will reside at: *

Address Line 1

Address Line 2

City

State

Zip Code

How years have you lived at the residence?

Selected Value: 0

If under 1 year choose 0

Choose One *

We verify home ownership.

If you rent are you allowed to have a dog? *

Yes
No
I don't rent

Does your lease have any restrictions on breed or size? *

Yes
No
I don't rent

If you own your own home do you have any restrictions on breed or size on your homeowners insurance? *

Yes
No
I am not sure

If you are part of a home owners association do they have restrictions on size or breed. *

Yes
No
I am not in an association

Do you have a fenced in Yard? *

Yes fully fenced 5 foot or Higher
Yes Fully fenced 4 feet
No

Check if any apply: *

WAHS Board Member
WAHS Active Volunteer
WAHS Active Staff Member
Not Applicable

Household Information

Please list members of household and ages.

Name

Age

Name

Age

Name

Age

Name

Age

Do children under 16 visit your home regularly? *

Yes
No

Meaning do you have family or friends children that will be around the cat with regularity due to babysitting, neighbors kids, etc.

Do you have a plan if you can no longer care for your dog? *

Yes
No

Do you have the financial means to feed and take your dog to the vet as needed? *

Yes
No

Have you ever adopted from the Washington area Humane Society before? *

Yes
No

Is this your first time owning a dog? *

Yes
No

Have you ever been charged with animal neglect, abuse or abandonment? *

Yes
No

Current Pet Information

List all the pets you have owned in past three years.

Are all your pets up to date on rabies vaccines? *

Yes
No
No but I will bring them in to get one.

Are all your pets spayed/neutered? *

Yes
No

Animal Adopting Information

What are the name(s) of the dogs you are interested in adopting.

I am interested in the following: *

Vet Office Phone 1 *

Vet Office Name 1 *

Vet Office Phone 2

Vet Office Name 2

Select qualities you like in a dog: *

Are you willing to adopt a dog with pre-existing medical conditions? *

Yes
No
Maybe, depends on issue

How many hours a day will the dog be home alone?

Selected Value: 0

When you are not home where will your dog be kept: *

you List no

Will your dog be kept indoors the majority of the time? *

Yes
No

If taken outside explain more: *

Are you prepared to care for the dog for its lifetime? *

Yes
No

Is there anyone in your household allergic to dogs? *

Yes
No

Do you expect the dog to be potty trained at time of adoption? *

Yes
No

If the dog has accidents how do you plan to handle the situation? *

Are you willing to provide behavior training for your dog? *

Yes
No

If the dog bites a person or another dog how would you handle the situation? *

Do you plan on crate training your dog? *

Yes
No

Please share anything else you would like us to know that would make you a good adoptive home.

I understand that the Washington Area Humane Society reserves the right to refuse adoption at their discretion for any reason. *

I understand

Signature

Clear Signature

I understand that WAHS only adopts dogs to live indoors in a home. We do not adopt dogs out for gifting to others. I know I must provide a vet contact for my current animals. I am aware that if I rent my landlord must approve of me having a pet and supply a landlord letter to process my application. I am signing above in agreement that everything I said in this application is true to the best of my knowledge and that falsifying information will lead to the cancellation of the application.