Dog Adoption Forms - Fairfield County
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1
2Fairfield County Dog
Adoption Center & Shelter
1715 Granville Pike
Lancaster, Ohio 43130
740▪ 652▪ 7180 Fax: 740▪ 681▪ 7457
dshelter@co.fairfield.oh.us
Fairfield County Dog Adoption Center & Shelter
Dog Adoption Form
Customer Profile:
Name:
Age:
Phone:
Address:
City:
State:
Zip:
Email Address:
□YES
□ NO
Length of Time at Current Address:
Are you a Renter?
Landlord Name:
Landlord Phone #:
□ YES
□ NO
□ UNKNOWN
Does your home owners insurance allow this breed?
Household Profile:
Names and Ages of all others living in Household:
________________________________________________________________
________________________________________________________________
________________________________________________________________
□ YES
□ NO
Does anyone in the Household have an allergy to dogs?
Name, Age, Species and Breed of Current pets:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
□ YES
□ NO
Do you have a Fenced Yard?
If yes please select fence type:
□ Chain Link
□ Wood/Panel □ Electric
□ Other_________________
Fence Height: ________________________
If you have no fence please indicate how you plan to provide exercise for your dog?
______________________________________________________________________________
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