Dog Adoption Application

Please enter your name:
Address:
City:
State:
Home Phone:
Work Phone:
Cell Phone:
Please enter your email address:
What dog are you applying for?:
Do you have time for a pet?	Yes No
Are you prepared for the cost of pet ownership?	Yes No
Is this pet right for you and your family's lifestyle?	Yes No
Can you make a long-term commitment to the pet?	Yes No
How did you hear about MEHS?:
Your Pet History
Have you surrendered a pet to us before?	Yes No
If yes,what kind of pet and why was it surrendered?:
Have you adopted a pet from MEHS before?	Yes No
If yes, what type:
Do you still have the pet?	Yes No
If no, explain why?:
Is the dog you are applying for today for your household?	Yes No
If no, for whom are you adopting?:
Do you have pets now?	Yes No
If so, how many?:
First Pet Species/Name:
Spayed/Neutered?	Yes No

Second Pet Species/Name:
Spayed/Neutered?	Yes No

Third Pet Species/Name:
Spayed/Neutered?	Yes No

What is the name of your current veterinarian or clinic?:
If you presently have a dog,please name the brand of heartworm preventative used and the last date it was given?:
If you don't have pets now,have you had any in the last 5 years?	Yes No
Most recent pet species?:
What happened to this pet(if she/he died, briefly explain the circumstances)?:
I live in a:	House Apartment Mobile Home Townhome Other
Do you rent?	Yes No If yes,Landlord's name: Landlord's Phone Number:
This residence is:	Permanent Temporary
Number of children living in house?:	Age of children?:
Number of adults living in house?:
Are all adults aware that you are adopting a dog?	Yes No
Please discribe your family/household on a scale from 1 to 5 with 1 being very low and 5 being very high.	Attention Available for Pet: Energy Level of Household: Traffic Level of Household:
I am looking for a pet that has the following traits(check all that apply).	Quiet and Laid-back Active and Athletic Very Clean Requires very little work Housetrained Will follow my rules with training Doesn't need obedience training
How long will the dog be left home alone throughout the day?
Will this dog ever be kept outside?	Yes No
If yes, Discribe where she/he will be kept and for how many hours a day:
Do you have a fenced-in yard?	Yes No
If yes, height and type:
If there is no fence, how often will you walk the dog?
Most shelter animals have uncertain health and vaccination histories. MEHS offers a "Healthy Pet Warranty" which includes a free physical exam, and should your pet become ill* within 14 days of adoption, your pet can be treated at no charge to you at Horseshow Lake Animal Hospital. This warranty is only valid if you schedule your initial exam at Horseshoe Lake Animal Hospital within 72 hours or 3 business days of adoption.Are you prepared todo so?	Yes No
If no, why?
If you relinquish custody of the dog, do you agree to bring him/her back to MEHS?	Yes No
By typing your name, you certify that all information given is true to the best of your knowledge.
Date

Dog Adoption Application

Your Pet History