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Dog/Puppy Adoption Application

Before you succumb to falling in love with a puppy or dog, ask yourself the following question: "Do I really want a dog and all the responsibilities that come with having one?" The reality is that adopting a dog or puppy requires a 10 - 20 year commitment on your part and you need to know if you are ready for that commitment. If you have made the commitment to have a new dog or puppy for yourself or family, we will work with you to find a dog whose requirements match for your life-style, expectations, experience and needs. We will offer training resources to you to help you in the trasition period of having a new dog/puppy in your home.

The dogs and puppies that come into our adoption program have either abandoned, picked up as strays but no owner found or have been given-up because their owner no longer can or will care for them. Sheltered dogs are loving animals that may not have been provided the training or care necessary by their previous guardians to make them an easy pet to live with. Because of this, all of our dogs live in homes with a foster care provider. The foster care provider helps assess the dog's raining, needs, and personality which helps this humane society place the dog/puppy into the most appropriate matched home and situation.

The adoption process for each dog occurs over approximately one week's time because of coordinating schedules for all parties involved. We do our best to expedite the process efficiently and effectively so we ask your patience and understanding. If you are interested in a specific dog, please complete this application and submit it online. After your application is received, it will be reviewed. We will contact you for clarification and conversation. If we feel you are a good match for the dog/puppy you are applying for, we will schedule a meeting and interview time with you. Please note that all household members should be present during the interview. Depending on the situation, including additional pets, a home visit may be required.

A Caring Place Humane Society reserves the right to approve or deny any application or application base on this organization's adoption criteria as well as the presumed needs of the dog or puppy being applied for. Completion of this application does not guarantee an approval for adoption nor does it place a hold on any animal.

Please read this Application and fill in the blanks. The information you provide in the Application and during our interview will help us find a good match for you.

Applicant/Co-Applicant information

Applicant

Last Name:
First Name:
Date of Birth:

Co-Applicant

Last Name:
First Name:
Date of Birth:

Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Email Address:

Illinois Driver's License Number:

What is the name of the dog that you are applying to adopt?:

How long have you been looking for a dog? :

Why do you like the dog you have expressed interest in? :

Is this dog for you/your family?:

Yes
No

If no, then who?:

Have you owned this breed/mix type previously?:

Yes
No

Will this dog be a ... :

Companion for self/family/child
Companion for another dog
Gift
Guard/watchdog

Household Information

Do You...:

Own
Rent

If you are renting, does your lease indicated pet restrictions?
(Please provide a copy of your lease for verification.) :

Yes
No
NA

Landlord's/Condo Board's contact name:

Landlord's Telephone:

Does your home have a yard? :

Yes
No

If so, is it fenced? :

Yes
No

If so, which height and type? :

Do you have any plans to move in the near future? :

Yes
No

If you had to move, what would you do with your pets?:

Family Information

How many adults are in the household?:

Relationships:

Have all the adults in the household agreed to this adoption?:

Yes
No

How many children live in the household?:

Ages:

Have they previously lived with dogs? :

Yes
No

Was it successful? :

Yes
No

Do you expect your current household situation to change?:

Yes
No

In what way?:

Who in the household has allergies and to what animals?:

How are the allergies treated?:

What is your family's current lifestyle?:

On the Go
Moderately Active
Unhurried

Does the entire family want a new dog? :

Yes
No

Why not?:

Why would you like to adopt an animal from us?
(Please mark all that apply.):

Companion for self
Companion for another pet
Companion for another household member
Companion for child
Gift for Household member

Adoptive Dog Information

Will the dog for which you are applying be an indoor family pet or an outside guard dog? :

How much time are you prepared to allow your new dog to adjust to your household? :

How many hours each day will this dog be left alone? :

Where and how will the dog be kept when you are not at home?
Please check all that apply.:

Indoor
Crated
Closed in Room
Basement
Garage
Porch
Gated in Room
Free run of house
Outdoor
Fenced Yard
Tied Outside
Kennel Run
Dog House

How many times per day will you be taking this dog outside for elimination?:

What method will you use to housetrain this dog? :

What will you feed this dog? :

How many times a day will you feed it? :

Where and how will the dog live while you are at home?
Please check all that apply.:

Indoor
Crated
Closed in Room
Basement
Garage
Porch
Gated in Room
Free run of house
Outdoor
Fenced Yard
Tied Outside
Kennel Run
Dog House

Where and how will the dog sleep at night?
Please check all that apply.:

Indoor
Crated
Closed in Room
Basement
Garage
Porch
Gated in Room
Free run of house
Outdoor
Fenced Yard
Tied Outside
Kennel Run
Dog House

Who in the household will be the dog's primary care giver?:

How much money do you expect to spend on maintenance for this dog, including food, in one year's time?:

What is the monetary limit you would spend on veterinary care should a serious illness or injury occur?:

When you are out of town, who will be the dog's primary care giver?:

Will you take this dog to obedience classes? :

Yes
No

Where & When?:

What will you do if this dog develops a problem with.... Please be specific in your response.

Digging:

Barking:

Chewing:

Separation Anxiety:

Aggression:

What issue are you not willing to work through that would cause you to return this dog to the humane society instead of keeping it?:

Current Pet Information

How many dogs do you currently have living in your home? :

Has your dog lived with other dogs previously?:

Was it successful? :

Yes
No

First Dog's Name:

First Dog's Breed:

First Dog's Age:

First Dog's Gender:

First Dog's Spayed/Neutered:

First Dog's Health Issues:

Where does your dog(s) live when you are at home?
Please check all that apply.:

Indoor
Crated
Closed in Room
Basement
Garage
Porch
Gated in Room
Free run of house
Outdoor
Fenced Yard
Tied Outside
Kennel Run
Dog House

Where does your dog(s) live when you are out of the house?
Please check all that apply.:

Indoor
Crated
Closed in Room
Basement
Garage
Porch
Gated in Room
Free run of house
Outdoor
Fenced Yard
Tied Outside
Kennel Run
Dog House

Where does your dog(s) sleep?:

Has your dog(s) gone through obedience training?:

Yes
No

When and with whom?:

What is the name, address, and phone number of your current/past veterinarian?:

Past Pet Information

Past Dog's Name (1):

Past Dog's Breed:

Past Dog's Age:

Past Dog's Gender:

Past Dog's Spayed/Neutered:

Where is the animal now?:

Where did you get them from?:

Past Dog's Name (2):

Past Dog's Breed:

Past Dog's Age:

Past Dog's Gender:

Past Dog's Spayed/Neutered:

Where is the animal now?:

Where did you get them from?:

Past Dog's Name (3):

Past Dog's Breed:

Past Dog's Age:

Past Dog's Gender:

Past Dog's Spayed/Neutered:

Where is the animal now?:

Where did you get them from?:

Have you ever given an animal away or relinquished an animal to a shelter? :

Yes
No

If yes, what were the circumstances? :

How were you referred or directed to this organization or animal:

REFERENCES: Please list two personal references that are NOT family members.

Name:

Relationship:

Phone:

Name:

Relationship:

Phone:

Home Visit

o you agree to allow A Caring Place Humane Society to visit your home by appointment as part of our applicaion process?:

Yes
No

APPLICATION INFORMATION: All of the information I/we provided in this application is true and correct. If any of the information changes, I/we will advise you promtply.

Date:

Signature:

Spouse/Partner/Roommate Signature: