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Humane Society of Terrell County Dog/Puppy Adoption Application Terrell County Which pet(s) are you interested in? Applicant Name: Age: Occupation : Place of Employment: Home Address: Home Phone: Email Address: City, State & Zip: Alt Phone: Co-Applicant: Name: Age: Occupation : Place of Employment: Which type of housing do you live in? House Apartment Condo/Townhouse Mobile Home Do you... Own your home Rent your home Live with parents If you rent do you have your landlord's permission to own a dog? Apartment complex and/or Landlord's name and phone number: Yes Yes No Do you have a fully fenced yard? If so, what type of material is the fence and how high is it? If no, how will the dog be secured when outside? Run free Leash Pen Chain Runner Other: Tie_Out How many times have you moved in the past 5 years? If you move, will your pet(s) go with you? Yes No Would you consider moving somewhere that doesn't allow pets? Yes No Human Society of Terrell Count Dog/Puppy Adoption Application. Page 1 of 4 www.HSTCO.org No Please list the name, age, and relationship to applicant of any other members of your household. NAME AGE RELATIONSHIP Does anyone in your household smoke? Have allergies? Yes Yes No No Will this dog be a surprise for anyone living in your house? Yes No ; If YES, then who? What activity level best describes your home? Busy- visits by friends, meetings, parties, children Moderate - normal comings and goings Quiet - "homebodies", few guests Current and Past Pets: How many pets do you currently have? Cats: Dogs: Other (please specify) : Please list each pet's name, age, and breed: Pet Name Age Are your current pets spayed or neutered? If not, please explain: Are your pets on heartworm prevention? Yes Yes Breed No No; Flea prevention? Yes No Besides those listed above, how many other pets have you had in the last five years? Cats: Dogs: Other (please specify) : Please list each pet's name, breed, and what happened to each of them (put to sleep or died (please give reason as run over, given away, sold, ran away, etc.): Pet Name Age Breed What Happened Have any of your current or past pets ever had a serious illness, injury, or behavior Yes No. problem? If YES then please describe: Human Society of Terrell Count Dog/Puppy Adoption Application. Page 2 of 4 www.HSTCO.org Have you ever surrendered a pet to a shelter or rescue group? Yes No. If YES then please explain the circumstances? Have you ever adopted a pet from a shelter or rescue group? If so, which shelter or group and when? Yes No Please check any of the following reasons for adopting this pet: Family Pet Child's Pet Watchdog Companion Companion for other pet Hunting dog Gift Other - please specify: List any general questions you would like to ask about this particular dog: 1. 2. 3. Who will be responsible for the daily care and training of this pet? Where will this pet live? Outside only Inside only Inside/Outside What procedures will you use for housetraining? Check all that apply: Crate training Paper training Rubbing nose Outside only Swatting with newspaper Other: How many hours will you dog be alone on a typical day? Where will your pet stay when you are not at home? Outside in a pen Outside on chain Tie-out Outside in fenced yard In garage Inside in crate Inside free run of house Inside one room of house Other: How do you plan to prevent fleas and ticks on this pet? How do you plan to prevent heartworm disease for this pet? What type of identification do you plan to use for this pet? ID tag Microchip Tattoo None If you are unable to keep this dog for any reason, will you return the dog to HSTC? Yes No What is the name and phone number of your veterinarian or vet clinic? Veterinarian or Vet clinic Phone Number Human Society of Terrell Count Dog/Puppy Adoption Application. Page 3 of 4 www.HSTCO.org What do you expect pet care (vet care, vaccines, food, toys, etc.) to cost yearly? $ A dog can live well over 10 years and requires a major commitment of time, finances, and emotion. Why do you feel you can make that kind of commitment at this time? References: Please list the name, phone number, and occupation of two personal references. Please do not include relatives. Reference Name Phone Occupation Number How did you hear about the Humane Society of Terrell County? HSTC website PetFinder.com Radio Newspaper Word of mouth At an adoption event or fundraiser Other: I have read the above information carefully and have filled out this application honestly and in its entirety. Falsification of any of the above information will be grounds for disallowing the adoption of the pet and possible removal of said pet from my home. Applicant must be 18 years of age or older. HSTC reserves the right to refuse any applicant. I give HSTC permission to investigate to the fullest extent of their legal capability, the information written above as well as conduct inquiries with landlords, veterinarians, and related officials. In addition, I understand that the decision of which animals are adopted to specific homes is dependent upon many varying factors, including but not limited to, the compatibility of home and family to the individual animal(s), and the amount of eligible applications received on this animal. I realize that it is HSTC's prerogative to place the animal in the home HSTC feels is most appropriate and that HSTC's decision is final. Checking this box designates my digital signature. When the Adoption is complete my normal signature will be placed below. Digital Signature: Date: Signature: ______________________________________ Date: ________________ Human Society of Terrell Count Dog/Puppy Adoption Application. Page 4 of 4 www.HSTCO.org