Dog Application Form

Please fill out this questionnaire. It is designed to help find a compatible dog with your lifestyle. It is our ultimate goal to match the right dog with the right home.

Printable PDF Version available if you prefer.

Name Of Dog You Wish To Adopt

Applicant Name

Address

City

State

County

Phone

Email Address

Home Status

Own House Rent House Rent Apartment

Landlord’s Name

Landlord’s Phone Number

How long have you lived at this address?

Employer

Employer Address

Employer Phone

Please List The Pets In Your Home

Are All Of Your Pets Spayed Or Neutered?

Yes No N/A

Are Your Animals Seen Yearly By A Veterinarian?

Yes No N/A

Veterinarian’s Name

Are Your Pets Current On Vaccines?

Yes No N/A

If You Have A Dog, Do You Have A Current Dog License?

Yes No N/A

Have You Ever Surrendered A Dog To An Agency Or Another Person For Any Reason?

Yes No

Who Is Going To Be The Primary Caregiver Of This Animal?

Why Do You Want To Adopt A Dog?

Do You Have A Securely Fenced Yard?

Yes No

How Many People Are In Your Household?

What Are Their Ages?

What Are The Working Hours Of The Adults In Your Household

Are Any Household Members Afraid Of Dogs?

Yes No

Does Anyone In The Household Have Animal Allergies?

Yes No

Did You Ever Have To Give Up An Animal Due To Allergies In The Household?

Yes No

How Many Hours a day will the dog be left without human companionship

Where Will The Dog Be Kept During The Day?

Where Will The Dog Be Kept During The Night?

Where Will The Dog Be Kept When Alone

What Will You Do With The Dog If You Move/Change Housing/Add On To The Family?

Are You Willing To Work With The Dog In Housebreaking Issues Should The Need Arise?

Yes No

If Your Work Schedule Changes, Are You Willing To Have Someone Come To Your Home To Care For Your Pet During Your Working Hours, Even If It Means Paying Someone?

Yes No

Do You Understand That It Can Take A Puppy 18 Months To “Settle”? Are You Willing To Meet This Challenge?

Yes No

Do You Accept That Changing A Dog’s Environment May Cause The Dog To Have Accidents, Especially In The Early Days Of The Adoption?

Yes No

The Average Dog Has A Lifespan Of 12 To 18 Years. Are You Willing To Make A Commitment To This Dog For The Rest Of His/Her Life?

Yes No

Pets Require Veterinary Care And Are Subject To Unpredictable Illness. Can You Afford A New Pet?

Yes No

Have You Ever Put A Pet Down Rather Than Pay Veterinary Care?

Yes No

What Do You Think The Most Important Responsibilities Are In Owning A Dog?

What Training Methods Have You Used In The Past?

Do You Plan On Attending Puppy School Or Dog Obedience Training?

Yes No

What Is Your Opinion Of Using A Crate For Training?

Do You Understand That A Crate Is A Training Tool And Not A Place To Keep Your Pet?

Yes No

How Did You Hear About Us?

Internet Friend Other

Have You Adopted A Pet From Us In The Past?

Yes No

If The Answer Is Yes, What Type? How Long Have You Had Pet?

Please Select What Best Describes Your Household.

Busy, visits by friends, in and out a lot, children, parties at our home Noisy, TV, Stereo, machinery, tools, children playing, dogs barking Moderate – normal comings and goings Quiet – “homebodies”, few guests, come home and stay home Live on busy street

I give the Humane Society of Westmoreland County permission to investigate all names and officials listed in this application. I understand that returning a cat for readoption is harmful to the well being of the animal. I, therefore, declare that all statements are truthful, and I will work to the best of my ability to meet all challenges.

We will respond to applicants via phone or email and if approved, the applicant will be required to sign the application upon their initial visit to the Humane Society.

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