Name:
Address:
Email address:
Phone number(s):
Occupation/Employer
Phone Number
Landlord Name/
Phone Number
Own or Rent?
Number of children &
ages in household:
Names of all adults in
household:
Does anyone in household have
allergies?
 Why do you want to
adopt a dog from us?
How many pets have you owned
as an adult?
Have you ever had to give up a
pet? If so, why & what happened
to the pet?
List the pets you have owned, their type/breed, spay/neuter status,
age, where kept, how long you had them, what happened to them
and if you still have them.
Name & number of
your vet(s)
Do you agree to take your pet to the vet for its
annual vaccinations & exam?
How much do you estimate it will cost to
care for your dog for one year (food, vet bills,
license, etc.)?
Have you ever adopted from a Humane Society before?
 If yes, explain:
Are you willing to allow a NHS representative to visit
your home by appointment to approve your application
prior to adoption?  If no, please give reason.
If you must move in the future, what will you do with
your pets?
Do you agree to contact NHS if you are no longer able to keep your adopted dog?
Rescued dogs need time to adjust to a new home.  Are you willing to give your new pet time to insure
proper adjustment (at least three weeks in many cases)?
IIf no, how much time will you
give the dog to adjust?
Who will have primary
responsibility for your dog's care?
IWill you take your dog to training class? If so, what type?
What would be unacceptable behavior in your home for you
to want to give up the dog
How long each day will your dog be home without human companionship?
If you don't have a fenced yard, how will you keep your dog safe?
Where will you exercise your dog or take it for walks? Will you use a leash?
Are you familiar with the characteristics of the breed of dog you are
interested in adopting
At nighttime?
Where will the dog be kept in the daytime?
When it is alone?
 Winter/Summer?
If the dog will be an outside dog, what type of shelter will it have?
If your new dog is not housetrained, how will you train it?
(training material available upon request)
What type of food do you plan to feed your dog? (brand, dry/moist)
Additional comments:
What type of ID will you place on your dog?
DOGS OFTEN LIVE 15 YEARS OR MORE.  ARE YOU PREPARED TO TAKE
RESPONSIBILITY FOR YOUR DOG'S ENTIRE LIFE???
If you have no veterinary references, please list 3
personal references with contact numbers:
The applicant hereby grants the Humane Society permission to confirm any information provided in this application with any
appropriate third party source, including landlord, veterinarian, etc. The information obtained will be held in confidence and
used only by the Humane Society for purposes of this adoption.  I certify that all of the above information is true and complete
and I understand that if any false information, ommissions or misprepresentations are discovered, my application may be
rejected.  I also understand that this adoption application is sole property of the Northwoods Humane Society.  It is specifically
understood that NHS reserves the right to deny an adoption application at its own discretion. By submitting this form
electronically, it is understood that the applicant has read and agreed to these terms and conditions.