Adoption Form - Dogs - Pembina Valley Humane Society

Name of Dog Interested In:

Full Name:

Email Address

Address:

(if rural, list both physical & mailing address)

City/Town/RM:

Province:

Postal Code:

Phone Number:

Alt Phone Number:

Are you 18 years of age or older?

Yes No

Preferred Contact Method:

Phone

Email

Best Time of Day To Reach:

Full names of all adults who reside in the residence:

List the ages of all children under 18 yrs:

Does anyone in the home have allergies to pets?

Yes No

Did all household members participate in this decision?

Yes No

Who will be primarily responsible for the care of your new dog (feeding, grooming, exercising, training)?

Why do you want to adopt?

Family Pet Guard Dog or Protection Hunting Gift Other

Do you live in a:

House Apartment Condo Mobile Home Other

For how long?

Do you:

Own Rent Live with Parents Other

What qualities are important to you in your next dog?

(example: calm, housetrained, athletic, affectionate, good with cats/kids/dogs, etc.)

How much and what type of exercise will your dog be provided?

How much time will the dog be alone?

Your dog will be kept:

Indoors Outdoors Barn Garage

Where will the dog sleep at night?

Indoors Outdoors

Type of confinement:

Fully fenced yard Dog Run Tied up Crate or Kennel Loose on Property Undecided

How/where will the dog receive exercise?

How often?

How many pets have you had in the last 5 years?

(Dogs, Cats, Other)

How many pets do you currently live with?

(Dogs, Cats, Other)

What breed of dog(s)/cat(s) do you have?

How old are your current dog(s)/cat(s)?

What types of training methods are you looking to use with your dog?

Are your pets spayed/neutered?

Yes No

Are your pets up to date on vaccines?

Yes No

Which veterinary clinic would have past or present records?

Which veterinary clinic will you take your new pet to?

Have you ever had to return or re-home a pet? If so, why?

Name:

Relationship:

Contact Phone #:

Email Address:

Best time of day to be reached:

Name:

Relationship:

Contact Phone #:

Email Address:

Best time of day to be reached:

Name:

Contact Phone #:

Email Address:

Best time of day to be reached:

Name:

Contact Phone #:

Email Address:

Best time of day to be reached:

A dog can live well over 10 years and requires a major amount of time, exercise, finances and emotional stimulation. Do you feel you can make that kind of long-term commitment at this time?

Yes No

Please check off all areas you would like to discuss with the shelter manager:

Introducing new dog to other pets

Kids & Dogs/Puppies

Housetraining

Diet/Nutrition

Obedience Training

Proper Socialization

Toys/Enrichment

Pet Identification

Kennel/Crate Training

Adoption Form – Dogs

Reference 1

Reference 2

Veterinarian

Landlord (if applicable)