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DOG ADOPTION APPLICATION
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To be considered as an adopter, you must: Be 21 years of age, have the knowledge and consent of all adults living in your household, have a valid ID with current address, have the knowledge and consent of your landlord (if applicable) and understand that the Siskiyou Humane Society must approve your application.
Name
*
First
Last
Phone
*
Email
*
Physical Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you have a different mailing address?
Yes
Mailing Address (if different from above)
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date of Birth - To be considered you must be 21 years or older.
*
Occupation
*
Please select your reason for adopting a pet:
*
Companion
Family Pet
Child's Pet
Companion for other pet
Gift
Guard Dog
Hunting Dog
Watch Dog
Other
Please explain:
Do you currently have any pets of your own?
*
Yes
No
If so, please provide names, types, breeds, genders, ages, spayed/neutered if indoors or outdoors, and how long you have owned them :
Are you adopting for someone else?
*
Yes
No
Please explain:
Are you aware the yearly vaccinations and routine preventative vet care typically costs between $80 - $200 per year?
*
Yes
No
Who is your Veterinarian?
*
How will you transport your pet home, to the vet, etc?
*
Have you ever adopted an animal from an animal shelter?
*
Yes
No
Do you plan on attending obedience classes with your dog?
*
Yes
No
If you drive a pick up truck, would you allow the animal to ride in the back/bed?
Yes
No
Other
Please Explain:
Previous dog owning experience (please select all that apply)
*
Never had a dog before
Had one or two growing up, this would be the first as an adult
Always have had one or more dogs
Always have had a particular breed or type of dog
Have experience working/volunteering with Humane Societies/animal welfare organizations
Have titled/certified dog in sports or activities
Have participated in obedience and/or puppy classes
Typical time away from home during the work week:
*
Home all day
1 - 3 Hours
4 - 6 Hours
7+ Hours
Other
Please Explain:
If you are gone during the day, is someone else home?
*
Yes
No
Is that person willing and able to be responsible for looking after the dog?
Yes
No
Maybe
Mark all that describe your lifestyle
*
Working during the week, relax on the weekends
Very active, daily outdoor exercise (hiking, walking, sports, etc)
Working during the week, active on weekends
Dedicated couch potato/sedate lifestyle
Can take dog to work regularly
Mostly home, prefer to stay there
Is your yard fully fenced
*
Yes
No
Partially fenced
Describe your fence - type of fence and height
Where do you plan to leave the dog when you are not home?
*
Inside house
Crated inside
Inside garage/outbuilding
Outside yard
Outside in kennel/run
Chain or tie out
Other
Please Explain:
Where will your dog sleep at night?
*
Inside house
Crated inside
Inside garage/outbuilding
Outside yard
Outside in kennel/run
Chain or tie out
Other
Please Explain:
How do you plan to exercise your new dog?
*
Daily leash walks
Daily games of fetch, etc.
Play in fenced yard
Daily hiking, swimming, or other outdoor activities
Visit to the dog park
Play with other dog at home
Other
Please Explain:
List any adults that will be living in the household with the pet. Please include age and relationship to each person listed:
List any children that will be living in the household with the pet. Please include age to each person listed:
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?
Are there any persons who regularly visit the home (grandchildren, family members, etc)? Explain and list visitor(s) ages below.
Does anyone in your home have allergies to dogs or have asthma?
*
Yes
No
List any animals that will be living in the household with the pet. Please include age, species and gender:
How did you hear about us?
*
Facebook
Radio
TV
Friend
Newspaper
Supersaver
Adopted here before
Other
Please Explain
Would you like to join our mailing list?
*
Yes
No
Would you object to an authorized representative of the SHS inspecting the animal and the house/home where the animal is kept?
*
Yes
No
Have you ever been convicted of a crime that involved an animal(s)?
*
Yes
No
By typing my full name below, I am certifying that all the above information is true and accurate. I also understand that a giving false information on this application is grounds for denying my application.
*
Email
Submit
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