Dog Adoption Form: The Humane Society of Greater KC

Welcome! We request the following information and a consultation with an adoption counselor to help you find a dog with the qualities you’d like and who matches your lifestyle.

To be considered as an adopter, you must: Be 21 years of age • Have the knowledge and consent of all adults living in your household • Have a valid ID with current address • Have the knowledge and consent of your landlord • Understand that The Humane Society of Greater Kansas City must approve your application (based on the policies set by the board of directors.)

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Best Phone Number *

Second Phone Number

Email Address (list best email to reach you by) *

Confirm Email Address *

Due to the large volume of applications we receive, we usually prefer to respond by email so that we can reply to everyone as quickly as possible. *

Yes, I can access my email daily

Sorry, I don't have daily access to email. Please call me at the "best phone" as indicated above.

Other: Other:

Your age: *

Please list the names and ages of all other adults and children living in your home: *

Where do you live? *

Do you: *

Own

Live with parents

Rent. Please list landlord's name, phone number and pet policy, including the amount of deposit or rent increase required: Rent. Please list landlord's name, phone number and pet policy, including the amount of deposit or rent increase required:

Are there any persons who regularly visit the home (grandchildren, family members, etc)? *

No	Yes, please explain and list their ages: Yes, please explain and list their ages:

Are there any dogs or cats who visit regularly? *

No	Yes, please explain: Yes, please explain:

Is anyone in your home allergic to dogs? *

No	Yes, please explain: Yes, please explain:

Please provide the following info about your current pets:

	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Sex	Spayed or Neutered?
1	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Sex	Spayed or Neutered?
2	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Sex	Spayed or Neutered?
3	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Sex	Spayed or Neutered?
4	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Sex	Spayed or Neutered?
5	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Sex	Spayed or Neutered?
6	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Sex	Spayed or Neutered?

Please provide the following info about pets you have had in the past 10 years but no longer have:

	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Spayed or Neutered?	Reason no longer with you
1	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Spayed or Neutered?	Reason no longer with you
2	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Spayed or Neutered?	Reason no longer with you
3	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Spayed or Neutered?	Reason no longer with you
4	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Spayed or Neutered?	Reason no longer with you
5	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Spayed or Neutered?	Reason no longer with you
6	Pet's Name	Type/Breed	Inside or Outside Pet	Age	Spayed or Neutered?	Reason no longer with you

Do you vaccinate annually? *

Yes

No

N/A

Other: Other:

Do you give your dogs heartworm preventative? (check all that apply) *

Who is/was your veterinarian for the above pets? List name and phone number: *

Are you interested in adopting a particular dog? *

No	Yes. Name of dog: Yes. Name of dog:

What type of dog are you looking for? (check all that you may be interested in) *

Why would you like to adopt a dog? (check all that apply) *

What qualities and behaviors are you looking for in your new dog? *

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What energy level are you looking for in a dog? *

High energy

Medium energy

Low energy

Not sure

How do you exercise your current dog, or how do you plan on exercising your new dog? (check all that apply) *

How often do you/will you exercise your dog? *

Do you have a completely fenced yard? If yes, describe the type and height: *

Does your home have a dog or cat door? *

No

Yes, dog door

Yes, cat door

Describe the living environment for your new dog: *

House pet, living inside with family, except for exercise and elimination

Pet will live in basement, garage, porch or sunroom

Pet will live mostly outside, inside in bad weather

Pet will live outside with a dog house

Pet will live outside with access to barn or other building

Other or comments: Other or comments:

How many hours each day will your dog be home alone (without human companionship)?
*

When home alone, your dog will be: (check all that apply) *

How important is it that the dog you adopt is already house trained? *

Describe the house training method you will use (or tell us if you need advice): *

What type of obedience training do you plan to do with your dog? (check all that apply) *

What will you do with your dog if you move in the future? *

How much do you expect to spend yearly on food, veterinary care, and other costs associated with caring for your dog? *

What would you do if the vet bills went over this amount? *

Would you allow our representative to visit your home before the adoption is completed? *

Yes

No

Are you prepared to make a commitment to care for your new dog for his/her entire lifetime, which could be 10 to 15 years or more? *

Yes

No

Have you made provisions for your pet if something should happen to you? *

No

Yes: Yes:

It may take your new dog two or more weeks to adjust to your home, especially if other pets are involved. Are you prepared to allow this much time? *

Yes

No

Have you adopted a pet from us before? *

No

Yes: Yes:

Are you a volunteer with The Humane Society of Greater KC, or affiliated with our organization, or know someone affiliated? If yes, please explain. *

Is there any additional info you’d like to provide?

0/500 characters

How did you hear about us?

By submitting this form, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application. I understand that this application is property of the Humane Society of Greater Kansas City. *

I agree

House	Apartment	Condo
Duplex	Mobile	Other Other

Male	Small (up to 20 lbs)
Female	Medium (20 to 40 lbs)
Puppy	Large (40 lbs and up)
Adult	Special Needs: Medical
Senior	Special Needs: Behavioral
Particular Breed: Particular Breed:

Companionship	Friend for my pet	For the kids
Gift	Inside family protection	Outside guard dog
Hunting	Breeding	Other: Other:

Leashed walks	Playing fetch
Leashed jogs/runs	Tie-out in yard
Indoor play	Outdoor dog pen
Off-leash dog park	Treadmill
Playtime in fenced yard	Hiking
Playtime in unfenced yard	Agility training
Other: Other:

Loose inside house	Outside in fenced area if nice weather
In a crate inside house until house trained	Outside in fenced yard
In a crate inside house	Outside free to roam in unfenced area
In a garage, sunroom, basement	Outside in dog pen
Inside or outside in fenced yard, using doggie door	Outside secured to a chain or cable
Will go to dog daycare	Other: Other: