Dog Adoption Application

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Columbiana County Humane Society
To help us make the best match for you and your family, please complete this form as accurately as possible.

Columbiana County Humane Society takes in abused, neglected, and abandoned animals; as well as those that are sometimes ordered removed by the courts. We make every attempt to screen our animals for health, behavior, and temperament issues. Certain types of problems may not demonstrate themselves until the animal is in a home environment.

Email *

Name of DOG you're interested in?

What attracted you to this DOG?

Applicant's Name:

Co-Applicant's Name:

Applicant's Street Address including city, state, zip and county:

Applicant's Phone Number:

Applicant's Alternative Phone Number:

Place of Employment:

How many hours typically do your work?

Do you own or rent your home?

If renting, what is your landlords name?

Landlord's phone number:

Is your yard fenced?

If you have a fenced in yard, what is the height, size and type?

If no fence, how will you handle the dogs exercise and toilet duties?

Do you have any children under 18 years of age? If so, please list ages:

Please list ALL pets you currently own, their breed, name, age, and if spayed/neutered:

Please list all pets you have owned in the past 5 years and what happened to them:

Vet's FULL name:

Vet's street address with city and state:

Vet's phone number:

What energy level best describes your home?

Low/couch potato, looking for Netflix buddy

Medium/walkers, playing ball in yard, dog park visits

High/hiking, biking, power walker, jogger

Clear selection

What period of time do you feel is reasonable to allow a dog to adjust?

Have you ever given a dog away for any reason? If so, when/why?

All dogs, even puppies, have a tendency to either have or develop behavioral issues. We describe every behavior we have witnessed, but as a shelter we are limited. What behavioral issues are you NOT willing to work with?

Excessive barking

Fear/Shyness

House Training

Destructive/ Chews

Separation Anxiety

Jumping

Runs Away

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What would prompt you to return a pet?

Do you plan on using a crate for your pet?

How many hours will the pet be alone on an average day?

Reference Number #1 (other than family member) who is familiar with your experience as a pet owner. Name, relationship, years known, phone number and best time to call:

Reference Number #2 (other than family member) who is familiar with your experience as a pet owner. Name, relationship, years known, phone number and best time to call:

If the pet you are interested in is NOT a fit for you based on your answers or is no longer available, please answer what best describes what you are looking for. Size, breeds, gender and age.

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