Dog Adoption Application (Page 2 of 2) in pdf

21. Are you aware that some ailments are managed through daily or short term medication? Yes / No

22.How much do you think you will spend yearly for the care of your dog including vet care, heartworm prevention,

flea/tick prevention, vaccines, food, toys, and bedding? ______________________Are you willing and financially able to

spend the necessary amount to properly care for your new dog? Yes / No

23. Please list all pets you currently have:

Name?

Type of Pet?

Age?

Spayed or

Indoor,

Is it

What vet does it go to? (Please provide

Neutered?

Outdoor,

Declawed?

the name of who the pet is under at the

Both?

vet clinic also)

Please list pets you have had in the past five years:

Name

Type of Pet

Vet Clinic Used (List name of who

What happened to the pet?

How long ago?

the pet is under at the vet clinic)

Your Name: _____________________________________________________________

Address: _________________________________________________________________

City, State, Zip: ______________________________________________________

Phone Numbers (two please): _______________________________________________________

Email Address: ________________________________________________________________

Would you like to receive our newsletter? Yes / No

Who are you interested in: __________________________________

I have answered all of the questions honestly and completely, I am over 18 years of age and can provide proof of ID, and

I understand that:



Adopting a pet is a long-term commitment.



WRHS reserves the right to refuse/reject my application at its discretion. Filling out this application does not

automatically approve me for the animal nor does it require me to adopt the animal.



I am giving permission to WRHS to contact my landlord and/or veterinarian that I have provided, and my

signature allows release of any information necessary to process this application.



Signing this form authorizes an investigation of all information and statements on this form and certifies that all

information is truthful and accurate.

Signature of Applicant: __________________________________________ Date _____________________________

PLEASE INITIAL HERE TO CONFIRM THAT YOU UNDERSTAND THAT FILLING OUT THIS APPLICATION DOES NOT

GUARANTEE THAT YOU WILL BE APPROVED TO ADOPT THE DOG/PUPPY __________________

Dog Adoption Application Page 2

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