Sheboygan County Humane Society
PRE-ADOPTION APPLICATION For DOGS


In order to be considered for an adoption today you must:
- Be 18 years of age
- Have the knowledge and consent of all adults living in your household
- Have verifiable identification
- Understand that the SCHS has the right to deny your application

So that we may be assured that the animal you want to adopt will be
best suited for you, your home and lifestyle, we would like you to provide us with
the following information. This form should take approximately
10-15 minutes to complete. Thank you for your cooperation.

Description of Dog that You’re Interested in:
Are you financially prepared to take on the added expense of a dog in your house? see cost of ownership Yes No

ABOUT YOU

* = required fields for this form to work

Applicant:   
*Name:
*Email:
*Street Address: 
*Home Phone:
(xxx-xxx-xxxx)
*City:
*County:
*State:
*ZIP:

Date of Birth
 (mm/dd/yyyy)
Cellphone:
(xxx-xxx-xxxx)
Employer: 
Occupation:
How long at current job?:
 years
Work Phone#
 (xxx-xxx-xxxx)
How many years have you lived at the above address?
 
  
Your Previous address (if less than 5 years)
City
County:
State:
ZIP:
Co-applicant (Spouse or Significant Other):
Date of Birth?
 (mm/dd/yyyy)
First Name:
 Last Name:
Employer:
Occupation:
How long at current job?:
 years
 

ABOUT YOUR HOME:
You live in: trailer/mobile home Apartment House
Do you: rent home own home  
Other Family Members:    
How many people are currently living at this residence?
Men:
number?
ages?
Women:
number?
ages?
Girls
number?
ages?
Boys:
number?
ages?
Please tell us the names of the people in your household:
Do you plan on moving in the next 6 months?
 Yes No Would your pet go with you if you moved?
 Yes No

List animals you currently own or that are in your care/house and those you have owned in the past five years, if you need more room list in comment box below:
Dog
Cat
Other		 Name

If other, what:

Breed:
Male
Female

Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
years		 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:
Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
years 		Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 		Breed:

Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
years 		Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:

Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
years 		Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:

Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
years 		Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:

Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
years 		Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:

Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
years 		Where is it
now?

ABOUT A NEW DOG/PUPPY IN YOUR HOME
Have you applied to adopt or adopted from our Shelter or other animal shelter before? yes no
If from another shelter, which one?
What veterinary hospital do you use (or do you plan to use)?
Are your current pets up-to-date with their vaccinations?

Under whose name are the veterinarian hospital records?
Please list your veterinarian's phone number (xxx-xxx-xxxx)

Can you provide a permanent home for this dog for 10-15 years?

 Yes No
If no, please explain:
Who is going to be the main dog caregiver?
What best describes the main pet caregiver?  (check all that apply)

 
On an average day, how many hours will your dog be left without human companionship?
Where does your current dog stay when home alone during the day?
Where will your new dog stay when home alone during the day?"
Where do current pets sleep at night?
Where will the new dog sleep at night?
Are you familiar with crate training?  Yes No
Would you crate train this dog if it was necessary?  Yes No
Do you have a fenced yard? Yes No
Do any family members have allergies? Yes No
Do you plan to let your pet have babies? Yes No
Have you ever given a dog up because it didn't work out? Yes No
If so, please explain the circumstances and what happened to it:
How do you intend to train this dog?  On my own  Obedience class  Other 
If other than obedience class, please tell us more about your training plan: 
How do you plan to exercise this dog? 
It may take your new pet two weeks or longer to adjust to its new home. Are you prepared to allow for this adjustment period? Yes No
Are you familiar with the pet laws in your area as they pertain to dogs? Yes No
How do you plan to housetrain (potty-train) your dog/puppy?
Are you familiar with the needs of the breed you have chosen?
Yes No

House training, excessive barking, digging, chewing (teething) on furniture and household objects, and jumping on people (these are very normal canine behaviors) are some of the issues that
you may have to deal with.
Are You Prepared to deal with these issues?

 Yes No

What brand of food do you plan to feed?
What type of ID will your dog wear?
Will you use a leash to walk your dog? Yes No
If you rent, do you have the landlord's permission to own a dog? Yes No
if yes, who is the landlord?
What is the andlord's phone number?
 (xxx-xxx-xxxx)
Are the people in your home experienced with dogs? Yes No
Is everyone in the household agreeable to getting a new dog? Yes No
Reasons for adopting this dog: check any that apply:
Other reasons - please specify:
Please enter any additional comments that you may have regarding this application:

For applicants outside of Sheboygan County:
References, outside of your family:
  Name Phone Number
1
 (xxx-xxx-xxxx)
2
 (xxx-xxx-xxxx)
3
 (xxx-xxx-xxxx)

Please list your area shelters and their phone numbers
  Shelter Phone Number
1
 (xxx-xxx-xxxx)
2
 (xxx-xxx-xxxx)
3
 (xxx-xxx-xxxx)

The undersigned applicant hereby grants the Sheboygan County Humane Society permission to confirm any information provided in this application with any appropriate third party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by the Sheboygan County Humane Society for purposes of this adoption application.

I certify that all the information on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I also understand that this adoption application is the sole property of the Sheboygan County Humane Society.

It is specifically understood that the Sheboygan County Humane Society reserves the right to deny any adoption application at its own discretion.

Typing your name below will serve as legal signature.
By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue dog and possible removal of said dog from my home. Applicant must be 18 years of age or older. We reserve the right to refuse any applicant.
Date: Driver's license #:

 

IF you have problems with this ONLINE form, Please follow the instructions below.

IF you have problems with this ONLINE form, please:
contact webmaster to report the problem
click HEREto download a form in .pdf format		 get your free .pdf reader here!
download adoption application in .doc format
THEN:
Get the form, type in the data, save the form, and send it to us as an attachment,
-OR
Fax it to us at 920-208-2204
-OR-
Snail Mail it to us at: SCHS
3107 N. 20th St
Sheboygan WI 53083
-OR-
Bring it in to the shelter!