Northwoods Humane Society
PO Box 82 Hayward, WI 54843
Dog Pre-Adoption Application
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Approved___
Denied___
PF___
Dog________________
Notified Y / N
Date______________
To help us help you and the dog you want to adopt be suited to each other, we would like you to fill out this application so that you and your
future pet may live happily ever after. .
ABOUT YOU AND YOUR HOUSEHOLD:
Name_________________________________________Home Phone:__________________________Day Phone:______________________
Address:______________________________________________________City:_______________________ State:_____ Zip:__________
How long at this address?_________Physical Address_____________________________City___________State_________Zip__________
Adopter Occupation________________________________________________________________Work Phone_______________________
Do you own or rent?_________________ Landlord's Name__________________________________________ Phone__________________
Name of other adults living in your household_____________________________________________________________________________
How many children?______________________ Their ages__________________________________________________________________
Do any of the above people have allergies?________________________________________________________________________________
Why do you want to adopt a dog from us?________________________________________________________________________________
YOUR EXPERIENCE WITH PETS
How many pets have you owned as an adult?_________Have you ever had to give up a pet? Y/N Why?_____________________________
What happened to the pet?____________________________________________________________________________________________
PETS YOU HAVE OWNED IN THE LAST FIVE YEARS:
Name Dog/Cat/Other M/F Spay/Neuter Breed Where Kept How Long Owned Still Own
M/F Y/N
M/F Y/N
M/F Y/N
M/F Y/N
M/F Y/N
M/F Y/N
If you don't have the above pets anymore, please explain what happened to them._________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Who is your veterinary clinic?_______________________________________________Phone #_____________________________________
Do you agree to take your pet to your Veterinarian annually for full vaccination and exam? Y / N
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? Y / N: Explain__________________________________________________________
Are you willing to allow a NHS representative to visit your home by appointment to approve your application prior to adoption? Y/N
If no, 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? Y/N
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)? Y/N
If no, how much time will you give the dog to adjust?________________________________________________________________________
Who will have primary responsibility for your dog's care?_____________________________________________________________________
Will you take your dog to training class? Y/N 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? Y/N
Are you familiar with the characteristics of the breed of dog you are interested in adopting? Y/N
Where will the dog be kept in the daytime? Inside / Outside At night? Inside / Outside
When it is home alone? Inside / Outside Winter/Summer? Inside / Outside
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 literature available upon request)
What type of food do you plan to feed your dog? (brand, dry/moist) ____________________________________________________________
What type of ID will you place on your dog?_______________________________________________________________________________
Additional comments__________________________________________________________________________________________________
___________________________________________________________________________________________________________________
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
Name ____________________________________________________ Phone #_________________________
Name____________________________________________________ Phone #_________________________
Name____________________________________________________ Phone #_________________________
......................................................................................................................................................................................................................................
The undersigned 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.
Signature Date