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1 1840 E. Lancaster ● Fort Worth, Texas 76103 ● 817.332.4768 Kindness, justice and mercy to every living creature DOG ADOPTION APPLICATION Welcome to the Humane Society of North Texas. Adopting a companion animal is a major COMMITMENT and a RESPONSIBILITY that should be taken seriously by all members of your family. The animals available for adoption at the Humane Society of North Texas (HSNT) are animals that we have received from anyone and anywhere throughout our open door policy. No animal is ever turned away. We do our best to screen the health of each animal as it is received during the time it is house at HSNT. However, there is always a chance that the animal is incubating a disease at the time of admission without showing any clinical signs of disease. This simply means that the animal appears healthy and if it had been exposed to disease before admission, the vaccinations it received at admission would be ineffective in combating the disease. In order to be considered as an adopter you must: • Be 18 years or older • Have identification showing your present address • Have the knowledge and consent of all adults living in your household • Be able and wiling to spend the time and money necessary to provide the training, medical treatment and proper care for the companion animal • Have the cash to pay an adoption fee (HSNT accepts checks with a valid TX driver’s license) • Understand that HSNT has the right to deny or approve your adoption application. The application will be retained in HSNT files. Please print or write legibly all your responses: DATE: _______________ NAME: __________________________ RESIDENCE PHONE: _________________________ ADDRESS: ____________________________________________ CITY_____________________ ZIP__________________ HOW LONG AT THIS ADDRESS? ______ DO YOU: Own ___ Rent ___ LANDLORD’S NAME ____________________ PLACE OF EMPLOYMENT? ______________________________________ WORK PHONE: ________________________ NO. OF ADULTS IN HOUSEHOLD _________ CHILDREN ____________ AGES: __________________________ WHO WILL BE RESPONSIBLE FOR YOUR DOG? ___________________________________________________________ COMPANION ANIMALS CURRENTLY IN YOUR HOUSEHOLD: Type/Name of Animal Spayed/Neutered Kept Where Time owned Age 1) _______________________ _______________ ____________________ ___________________ ________ 2) _______________________ _______________ ____________________ __________________ ________ 2 LIST YOUR PREVIOUS COMPANION ANIMALS: Type/Name of Animal Spayed/Neutered Kept Where Time owned Age Where is it now? 1) _______________________ _______________ ______________ ___________ ________ _____________________ 2) _______________________ _______________ ______________ ___________ ________ _____________________ NAME AND ADDRESS OF YOUR CURRENT VETERINARIAN: _____________________________________ WHERE WILL YOU KEEP YOUR DOG? (Check all that apply) _____HOUSE _____ KENNEL ______FENCED YARD _____GARAGE ______PATIO ______OTHER ______FENCED RUN ________CHAINED HOW MANY HOURS WILL YOUR DOG SPEND ALONE: _____WEEKDAYS ______WEEKENDS HOW LONG WILL YOU ALLOW FOR THE DOG TO ADJUST TO ITS NEW HOME? ____________________ IF YOU HAD TO GIVE UP YOUR ANIMAL, WHAT WOULD YOU DO WITH IT? _______________________ WOULD YOU OBJECT TO A FOLLOW-UP HOME VISIT BY HSNT? _________________ WHAT BREED DO YOU WISH TO ADOPT? ________________________ GENDER: _________ AGE: _____ IN SUMMARY, PLEASE WRITE WHY YOU WISH TO ADOPT AN ANIMAL FROM HSNT: _____________________________________________________________________________________________ _____________________________________________________________________________________________. CAN YOU KEEP YOUR NEW PET ISOLATED FROM EXISITING PETS FOR AT LEAST A WEEK? _______ WILL YOU ALLOW YOUR DOG TO PARENT A LITTER? ____YES _____NO EXPLAIN WHY? _____________________________________________________________________________________________ DO YOU WANT THE DOG FOR (Check all that apply) ____COMPANION ____BREEDER ____GUARD DOG ______ GIFT FOR WHOM? _______COMPANION FOR YOUR OTHER ANIMAL ______OTHER ______WATCH DOG ______ FIGHTING DOG DO YOU REALIZE YOU WILL PROBABLY HAVE TO HOUSTRAINWOULD YOU LIKE INFORMATION ON HOW TO HELP YOUR DOG BECOME ACCUSTOM TO ITS NEW HOME? _________ WOULD YOU LIKE INFORMATION ON HOW TO HOUSETRAIN YOUR NEW PET? __________ IF ADOPTING AN ADULT DOG, HOW MANY TIME S A DAY WILL YOU EXERCISE IT? _____________ DO YOU PLAN ON TAKING YOUR DOG TO OBEDIENCE CALLES? _____YES _______NO DO YOU WANT TO HAVE YOUR DOG SPAYED/NEUTERED? _____YES ____NO PLEASE EXPLAIN: ____________________________________________________________________________________________ 3 WILL YOUR DOG BE KEPT AT HOME OR WORK? ________________________________________________ ARE YOU FAMILIAR WITH HEARTWORM DISEASE? _____YES ______NO ARE YOU FAMILIAR WITH CORONA VIRUS DISEASE IN DOGS AND PUPPIES? _____YES ____NO WHAT TYPE OF BALANCED NUTRION WILL YOU PROVIDE YOUR DOG? __________________________ WHAT WILL YOU DO IF YOUR DOGS SHOWS DESTRUCTIVE BEHAVIOR? _____________________________________________________________________________________________ _____________________________________________________________________________________________ DOGS OFTEN LIVE LONGER THAN 10 YEARS, ARE YOU WILLING TO ASSUME RESPONSIBILITY FOR THE LIFE OF THIS ANIMAL? _______YES _______NO WHERE DID YOU HEAR ABOUT HSNT’S ADOPTION PROGRAM? ____FRIEND ____RELATIVE ____TV ____NEWSPAPER _____RADIO ____OTHER THE HUMANE SOCIETY OF NORTH TEXAS RESERCVES THE RIGHT TO REFUSE ADOPTION TO ANYONE. I CERTIFY THAT THE AVOVE IS TRUE AND THAT FALSE INFORMATION MAY RESULT IN NULLIFYING THIS ADOPTION. ADOPTOR SIGNATURE: ____________________________________________ DATE: ___________________ OFFICE USE ONLY: STIPULATION: ___________________________________________________ COUNSELOR: _____________ TDL: ________________________________________ D.O.B _________________ EXPIRES: _______________ COMMENTS: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________. APPROVED: ______________________ DISAPPROVED: _________________ PENDING; ________________