Dog & Puppy Application
Applications take our Adoption Counselor typically 24-72 hours to process. You will be contacted by email or phone call; please check both your email and voicemail for potential messages. Our adoption fees for adults are $100-300 and for puppies are $150-300 (covers full vetting, spay/neuter, microchip, and care of the dog). Adoption fees are payable via cash, credit, or debit; we no longer accept checks. Fees will be paid at the time of adoption and may vary.
Submitting this application does not mean you are committing to a dog, nor does it guarantee you will get that dog. It is simply a tool we use to help both you and us identify a good potential match for your family and lifestyle. A successful adoption depends on selecting the right dog for your household and a good understanding of the dog's needs and care requirements. Please help us with this process by answering the following questions fully & completely. THANK YOU!
**Please note that any fields left blank will halt the application reviewing process.
Applicant Information
Adopter #1 Name: ____________________________________D.O.B ___/___/___
Adopter #2 Name: ____________________________________D.O.B ___/___/___
Adopter #1 Phone Number ____-____-_____ Email: _________________________
Adopter #2 Phone Number ____-____-_____ Email: _________________________
Adopter #1 Are you currently employed?: ___________________________________
Adopter #2 Are you currently employed?: ___________________________________
Home Address:
Street Name ___________________________ City/State/ZIP _________________
Do you live in (circle): single family duplex/twin apartment condo mobile home
Do you (circle): own rent deed/rent to own reside with relative
If you are not the owner of the home, please provide the homeowner’s information (name and contact information: __________________________________________________
How long have you lived at this residence? ________________________
List any residences you have had in the last 5 years: _____________________________
Household Information
Please list full names and ages of all permanent residents 18 and older: _________________
__________________________________________________________________
Ages of all permanent residents 18 and younger: ________________________________
__________________________________________________________________
Do you have frequent visitors between the ages of (circle):
0-5 years 6-12 years 13-18 years None of the above
Does anyone in the household have pet related allergies? __________________________
Who in the household will be the pet’s primary caregiver? __________________________
Pet Ownership
Have you adopted from the Quincy Humane Society in the past? If so, where is the pet now?
__________________________________________________________________
Do you currently have any pets? ___________________
If you currently have pets, please list them. Name, Age, Sex, Breed. ____________________
__________________________________________________________________
__________________________________________________________________
Are they up to date on vaccinations? Yes No Appointment is scheduled
Are they altered? (spayed/neutered) Yes No Appointment is scheduled
How many pets have you owned in the past 10 years? Where are they now? (Please list breed and ages)
__________________________________________________________________
Who is your veterinarian? Clinic Name __________________ Phone: _______________
Home Life
When will you be ready to adopt a dog/puppy? _________________________________
How many hours a day will your dog be alone? Explain. ___________________________
How will you exercise/entertain your dog? ____________________________________
How will you deal with unwanted behaviors such as barking, chewing, destructive behavior,
bathroom accidents, unruly leash behaviors, etc.? _______________________________
__________________________________________________________________
Do you plan on (circle): cropping the ears docking the tail debarking none
Why or why not? ______________________________________________________
How much do you reasonably feel you could afford/ would be willing to spend on your dog per month? (including things like veterinary care, monthly preventions, licensing, ID tags, food, toys, crates, training, supplies) $___________
Do you have a yard? ___________ Fence? __________ What kind? _______________
If you have a vertical fence, what is your fence height? ____________________________
Ideal Pet
Please describe your ideal pet. We will be able to recommend a perfect fit based on what you say
here. ______________________________________________________________
__________________________________________________________________
What kind of dog are you looking for? Circle: Indoor Outdoor Indoor/Outdoor
Where will your dog be when you’re home? _________________________________
Where will your dog be when you’re not home? ______________________________
Where will your dog be when you’re asleep? ________________________________
What energy level do you prefer? Crazy/Adventurous Medium energy Couch potato
Why do you want to adopt? Circle:
family pet companion for child companion for other dog(s) companion for other cat(s)
breed with current dog(s) to train for hunting therapy dog assistance to the disabled
guard dog/protection as a gift for a friend/partner/relative to train for agility
My adopted dog will (circle):
be indoors be outdoors outside during the day/inside at night roaming the farm
outside in a fenced area be outside on a lead line/cable in the yard be walked occasionally
be house trained before adoption be house trained by me/us be walked frequently
interacting with adults interacting with ages 0-10 years interacting with ages 11-18
be boarded for vacations stay with family for vacations go with on vacations
go camping with us go on boat trips with us attend agility classes
be given away if it’s no longer working be given to a shelter if it’s no longer working
Grooming needs (circle):
we prefer a non-shedder we prefer a low-shedder we don’t mind shedding
Have you discussed this adoption with all members of the household?________________
**We will be speaking to all adult residents to confirm everyone is aware of this application process and wants to have a dog added to this family. Please do not submit this application if you are "trying to talk someone into" adopting this dog or think that "once they meet the dog they will change their mind" or "I'm getting this dog as a surprise birthday present for someone". In those circumstances, you are more than welcome to email us to discuss the dog, but we would like all adults in the home to be involved in the email discussion.
What do you feel is a reasonable amount of time for a dog to adjust to a life with you and your
family? ___________________________
How do you plan to integrate this dog into your family? ___________________________
Have you ever turned an animal in to a shelter? ________ Why? ____________________
__________________________________________________________________
What would cause you to return a dog? _______________________________________
__________________________________________________________________
Please take time to think and be honest when answering the following. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?
housebreaking issues chewing counter surfing fear of men fear of women
fear of children too rough with other pets too much energy
growling biting too hard to train needs too much attention whining/crying
food/toy aggressive with pets food/toy aggressive with people separation anxiety
blindness limited sight deafness incontinence
diabetes special diet long term medication heartworm/flea prevention allergies
requires too much training gets stressed/sick in the car doesn't know how to use stairs
can’t climb stairs due to age/health heart condition trimming nails
yeast on coat/in ears ear mites fleas ticks heartworms yearly heartworm/lyme testing
We will do anything necessary to help this dog adjust
What would you do if after adoption (or at any time during your dog’s life) your vet diagnosed your dog with an expensive medical condition? ____________________________________________
_________________________________________________________________
Do you plan on getting pet insurance? Yes No I will look into it
Are you committed to providing a responsible home for your pet’s entire life? (could be 15 or
more years) Yes No
Are you willing to sign a legal contract agreeing to pet owner responsibility? Yes No
Do you have any additional questions, comments or concerns? Anything else you would like us to know in order to help match a dog with your family? ____________________________
__________________________________________________________________
What is the best way to contact you regarding your application? Phone or Email
__________________________________________________________________
Consent:
By my signature, I certify that the above information is complete and correct and that I am at least 18 years of age. I understand that completing this application does not guarantee I will be allowed to adopt a dog and that the application is a tool to help the Quincy Humane Society determine if this dog and my family are a good fit for each other. I understand that all dogs adopted from QHS will be spayed/neutered, heartworm tested, microchipped, and vaccinated prior to adoption. I authorize verification of all statements on this application, including but not limited to prior vet medical history. I understand that QHS has the right to deny my request for adoption. I understand that any misrepresentations may result in my not being approved and may lose the privilege of adopting an animal from QHS. If I am approved to adopt a dog, I agree to pay a non-refundable adoption fee and hand sign an adoption contract at the time of adoption. I understand that this application is the property of the Quincy Humane Society who reserves the right to share this information with other shelters and rescue organizations.
_____ By initialing this line I understand that QHS may conduct a background check and I agree to the above statements.
Adopter #1 Signature & Date Adopter #2 Signature & Date
_________________________ _____________________________