Q uinte
H umane
S ociety
Dog
A doption
A pplication
Office
U se
O nly:
Breed:_________________________
S ex:_____
A ge:_____
L og#:_______
N ame:___________
Name(s):______________________________________________________________________
Address:______________________________________________________________________
City:______________________________
P ostal
C ode:________________________________
Home
# :___________________
W ork
# :___________________
C ell
# :___________________
Email:________________________________________________________________________
_____________________________________________________________________________
Reason
f or
A doption
( check
a ll
t hat
a pply):
!hunting
! breeding
! watchdog
! playmate
f or
c hild
!pet
&
c ompanion
! competitive
d og
s ports
! guard
d og
f or
b usiness
o r
p roperty
!other
( please
e xplain)________________________________________________
Do
y ou
f eel
t hat
a
d og
i s
a
l ifetime
c ommitment?
! Yes
! No
If
y ou
h ave
t o
m ove,
w ill
y ou
l ook
f or
a ccommodations
t hat
a llow
d ogs?
! Yes
! No
What
w ould
b e
a
r eason(s)
y ou
w ould
r eturn
a
d og?
!chewing/destructiveness
! digging
! barking
! mouthing
! runs
a way
!not
h ousetrained
a nd/or
f ailure
t o
h ousetrain
! allergies
! not
g ood
w ith
k ids
!not
g ood
w ith
o ther
d ogs/cats/livestock
! moving
! change
o f
l ifestyle
!other
( please
e xplain)_________________________________________________________
Do
y ou
p lan
t o
c rate
t rain
t his
d og?
! Yes
! No
If
n o,
w hy
n ot?
_ _____________________________________________________
Are
y ou
w illing
t o
a ttend
o bedience
c lasses
i f
r equired:
! Yes
! No
Please
l ist
a ll
p ets
y ou
c urrently
o wn
_ ____________________________________
Which
o nes
a re
s payed/neutered?
_ _____________________________________
Do
t hey
v isit
t he
v et
r egularly,
a nd
a re
t hey
u p
t o
d ate
o n
s hots?
! Yes
! No
List
a ll
d ogs/cats
y ou
h ave
h ad
i n
t he
p ast
( that
y ou
d on’t
o wn
n ow)
_ ___________
Have
y ou
e ver
s urrendered
a
p et
t o
a
h umane
s ociety,
d og
p ound,
o r
r escue?
! Yes
! No