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

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

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

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?

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 many pets have you had in the last 5 years?

(Dogs, Cats, Other)

How many pets do you currently live with?

(Dogs, Cats, Other)

Are your pets spayed/neutered?

Yes No

Are your pets up to date on vaccines?

Yes No

Which veterinary clinic will you take your new pet to?

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

A dog/cat 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

Name:

Relationship:

Contact Phone #:

Email Address:

Name:

Relationship:

Contact Phone #:

Email Address:

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