Society of Humane Friends

SOCIETY OF HUMANE FRIENDS DOG ADOPTION APPLICATION
Please indicate which dog(s) you interested in adopting.

First Name:
Last Name:
Address
City
State:		ZIP
Phone Numbers: (XXX) XXX-XXXX
Home:
Work:
Cell:
EMail:

How long have you lived at your present address?		Years Months Days N/A
Which of the following applies?
	House Apartment Mobile Home Town House Condo N/A
How many people live in your household?
Do you foresee moving in the near future?		Yes No N/A
Do all family members know of your plan to adopt?		Yes No N/A
Are you or your spouse currently employed?		Yes No N/A
Are you 18 years or older?		Yes No N/A
Do you live with your parents or relatives?		Yes No N/A
Are there children in the household?		Yes No N/A
How old are they?
Who will be the primary caregiver?

Why do you want a dog?
What size do you prefer?
What age do you prefer?
What sex do you prefer?		Male Female Either
Must dog be housebroken?		Yes No N/A
How many hours a day will this dog be unattended?
Where will this dog be kept when you are not at home?
Would you take this dog to obediance training?		Yes No N/A

Do you currently have pets?		Yes No N/A
If so, what type?
Are they all spayed/neutered?		Yes No N/A
How many dogs have you owned in the past?
Where are they now?

Has a dog died on your premises in the last three months from distemper, parvo, or any unknown diseases or causes?		Yes No N/A

Where do your present pets live?
Where will your new pet live?
Where will your new pet sleep?
Is there a yard available?		Yes No N/A
Is it completely fenced in?		Yes No N/A
If so, how high is the fence in feet?
How will your new pet be exercised?
Are your present pets up to date on shots?		Yes No N/A
Who is your veternarian?
What would you say annual preventive veternary care would be for a dog?
What do you plan to do with your dog when you go on vacation?
What procedures will you use for housebreaking and destructive behavior?

Are you aware of hearworm cause and preventeion?		Yes No N/A
Have you ever taken a dog to the shelter before?		Yes No N/A
If so, why?

Would you object to an authorized Society of Humane Friends representative inspecting the premises where the animal will be kept both before and after adoption?		Yes No N/A
Please provide a reference:
Name?
Address?
City, State, ZIP?
Phone Number?
I attest that the above information is accurate. I am also relieving the Society of Humane Friends of any and all liability during the viewing and adoption process.
I Agree to all of the aforesaid.
NOTE: Completion of this form does NOT entitle an adoption. SOHF reserves the right to refuse any and all adoptions for ANY reason. This form is for screening purposes only.