DOG ADOPTION APPLICATION

Welcome to the Humane League of Lancaster County. We are glad that you have come to adopt a dog from our shelter. The following information is requested so that your adoption counselor can better assist you in the selection of a lifetime companion. Each animal’s welfare is our foremost consideration.

The dogs available for adoption came here from a variety of sources. We cannot guarantee the dogs health or temperament. All animals are examined by a kennel technician upon entry. Their health is routinely monitored while at the shelter, however there is always a chance that they are incubating a disease with out showing any clinical signs. Please initial here that you understand the above______________________

Be prepared that a yearly vet exam (including heartworm prevention) can cost up to $100 a year for a dog. Puppies need vaccinations and worming that can cost up to $50 a month for the first four months in you care. Please initial here that you understand the above______________________

We consider the adoption of a pet to be a life-long commitment of time, affection, money, patience and responsibility.

IN ORDER TO BE CONSIDERED AS AN ADOPTER TODAY, YOU MUST:

• Be at least 18 years of age
• Have a picture ID showing your current address
• Have the knowledge and verifiable consent of your landlord
• Have the knowledge and consent of all adults living in the household
• Understand that we have the right to verify any information on this application, including a property check, and to enforce any provision of the contract in the future

NAME______________________________________________________________________________________________

ADDRESS (street, city, state, zip) ________________________________________________________________________

____________________________________________________________________________________________________

Home phone #_______________________Cell phone #_______________________Work phone #_____________________

Place of employment___________________________________ Are you a student? ________ Are you over 55? _________

Drivers license/State ID # __________________________________

Do you live in a: ___House  ___Apartment  ___Trailer  ___Townhome              Do you: ___own  ___rent  ___live with parents

Are you in the process of moving, or anticipate moving in the next few months? ___yes   ___no

If you rent, landlords name and phone number_______________________________________________________________

FOR OFFICE STAFF USE ONLY

Person Code________________________

DNA check_________________________

ID check___________________________

Landlord approval___________________

Adoption Information

Do you feel you have given enough thought to this adoption? ___________________________________________________

Have you adopted from us before? When? __________________________________________________________________

Are you prepared to assume the financial responsibilities of providing your dog with adequate food, medical care, housing, training, toys, etc.? (Approximately $500 or more a year) _____________________________________________________

Are you prepared to commit to your new dog for the next 10-15 years? ___________________________________________

Can you schedule your lifestyle to accommodate the needs of a dog? _____________________________________________

Why do you want a dog? ________________________________________________________________________________

Who will care for this dog? ______________________________________________________________________________

What is you past experience with dogs? ___first time owner  ___have had one or two dogs  ___had a dog as a child 

___experienced

Do all members of you household agree on adopting? _______________________________________________________

Have you ever surrendered or given away any pet to another shelter or rescue? ______ If so, please explain ______________

____________________________________________________________________________________________________

Pet Information

Have you ever had a dog ___run away  ___get hit by a car  ___die in your care? If so, please explain__________________

___________________________________________________________________________________________________

What pets do you currently have in your household? (Circle each appropriate answer)

Do your current pets get along with dogs? __________________________________________________________________

What are you pets reactions to new dogs? ___________________________________________________________________

Has your pet ever nipped/bit any animal or person? _____ if so please explain _____________________________________

Are your pets up to date on vaccinations? ________ if not please explain__________________________________________

Who is your veterinarian? _______________________________________________________________________________

Household Information

Spouse/Partner/Roommates name? ________________________________________________________________________

List the ages of all children in your home ___________________________________________________________________

Do young children (not your immediate family) ever visit your home? ____________________________________________

What is the activity level of your home? ___quiet  ___active  ___very active

Does anyone in the household have allergies to animals? ________ If yes, are they taking allergy medication? ____________

If you move, have you considered that another landlord may not allow pets? What will you do if this happens?____________

____________________________________________________________________________________________________

New Pet Information

Please understand that it may take a new dog two or more weeks to adjust to a new home and/or to other pets and visitors

 Are you willing to give a new dog adequate time to adjust? __________________________________________________

How would you keep a dog confined to your property? (check all that apply)

___Free run of house  ___Crate in house  ___Fenced yard  ___Outside on chain  ___In garage  ___Yard with electric fence

Other (please explain) _________________________________________________________________________________

Where will the dog be kept during the day? _________________________ At night? _______________________________

How may hours will the dog spend alone? __________________________________________________________________

Where will the dog be kept when alone? ____________________________________________________________________

Do you want a dog for: (check all that apply)

___House pet   ___Guard dog   ___To breed   ___Companion  ___Travel companion   ___Gift for someone else

 ___Therapy dog   ___Dog sports   ___other (please explain) ___________________________________________________

Would you like information on how to house train and/or crate train your new dog? ___yes   ___no

Are you familiar with the leash laws in your community, township limits, and PA dog laws? ___yes   ___no

Will you abide by these laws? ___yes   ___no

Are you familiar with heartworm disease? ___yes   ___no

I certify that I have read this questionnaire and that all information I have given is true and accurate, and that I understand that any falsification may result in the nullification of an adoption.

_________________________________________________                                     ________________________________

Signature                                                                                                                                 Date

Please remember: We receive no county, state or federal funding. We operate solely on donations and adoption income.

**The Humane League reserves the right to deny any adoption**

Note: You must be present at shelter to be approved for adoption!

We do not accept applications by email.