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Butenhaus4Dogs Adoption Application
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Email *
Which dog are you interested in adopting? *
Full Name *
Contact Number *
Address (Street, City, State, Zip) *
How long have you lived at your current address? *
Do you own or rent your home? *
If you rent, name & phone number of property owner/manager.
Names and ages for all individuals in the household *
Employment Status *
If employed, current employer and contact number
Have you ever adopted a pet from a rescue or shelter? *
If yes, which rescue/shelter?
Do you have other pets in the household? *
If yes, please list the name, sex, species & breed
Name and contact for current Veterinarian *
Are your pets spayed/neutered? *
If no, what is the reason they are not spayed/neutered?
Where will your dog be kept during the day and at night? Do you use a crate? *
How many hours will your new dog be left alone?  *
Training method(s) used in the past and what is your training plan for the new dog? *
How will you exercise and mentally enrich your new dog? *
Do you have a fenced in yard? *
If no, how will you manage your new dog outside? *
Have you ever surrendered, or rehomed a pet? *
If yes, please explain
Please provide two personal references who do not live in the same household (name, relationship, phone number, email). *
Do you live within 1.5 hours of Port Washington, WI? *
Is there any additional information you would like to share with us?

I attest that the information provided above is truthful and accurate. I understand that providing false information may result in my adoption request from Butenhaus4dogs being revoked. I acknowledge that Butenhaus4dogs reserves the right to deny my adoption request. I authorize the verification of all information provided in this application, including veterinary records, landlord/management references, contacting mutual acquaintances, and consulting other humane societies/rescues. I release Butenhaus4dogs from liability for damage or injury caused by animals in their care during or after adoption. Butenhaus4dogs will retain this application form. Butenhaus4dogs retains the right to refuse any adoption for any reason."

After reviewing the statement and ensuring it accurately reflects your understanding and agreement, please type your full name below as your confirmation.

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A copy of your responses will be emailed to the address you provided.
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