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City of Tishomingo Dog Adoption Application
1130 East Main Street, Tishomingo, OK 73460
Telephone: 580-371-2369; Fax 580-371-2105
www.tishomingo.com
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***Incomplete Applications Will NOT Be Processed, Please Make Sure You Answer All Questions***
Today's Date:
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Your answer
Animal's Name
Your answer
Applicant's Name:
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Your answer
Address: Street, City, State, Zip Code
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Your answer
Phone Number:
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Your answer
Occupation:
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Your answer
Work Phone Number:
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Your answer
Do You Live In:
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House
Apartment
Condo
Townhouse
Other:
Do You:
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Own
Rent
If you rent, do you have their permission to have pets? Please provide the landlord's name and phone number:
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Your answer
Do you have any children under 10? If so, please tell us how many and their ages. Some dogs are great with kids, other dogs need to be in homes with no young kids.
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Your answer
Do you have a yard?
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Yes
No
If so, is the yard fenced in?
Yes
No
Clear selection
Height of Fence, Type, and Are the Gates Locked?
Your answer
Do you have other animals in the home?
If so, what type (cat, dog, etc), how many animals, and are they spayed and neutered? Vaccinated?
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Your answer
If you already have a vet for current or previous pets, please provide their name and phone number:
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Your answer
How much time do you expect the animal to be outdoors?
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Your answer
How much time do you expect the animal to be indoors?
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Your answer
About how much time will the animal be left alone and where will they be kept when left alone?
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Your answer
Where will the animal sleep?
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Your answer
Why do you want this animal? You can select multiple answers:
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House Pet
Family Companion
Companion for Other Animals
Family Protection
Business Protection
Watchdog
Gift
Other:
Required
**Please read the following statements and indicate your answer**
Pets are an investment of your time and energy. Can you afford to provide medical care, grooming, proper diet, proper shelter, and exercise for your new pet?
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Yes
No
Do you understand that animal cruelty/neglect is a
FELONY
in Oklahoma and animal control reserves the right to take custody of the dog if it is not receiving proper care?
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Yes
No
Do you understand that proof of rabies vaccination must be provided to Tishomingo City Hall and a fee of
$25
to license the dog and that both tags must be displayed on collars at all times? (This applies if you live within Tishomingo City Limits)
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Yes
No
I am outside of Tishomingo City Limits
Do you understand that this animal cannot be permitted to roam around "at large" within city limits and must be kept contained to your property unless on a leash accompanied by you as per the city's leash law?
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Yes
No
If your animal were injured or ill, are you committed to take them to the vet?
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Yes
No
Are you able to make a long term commitment to care for this animal for its entire lifespan, which could be as long as 10-20 years?
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Yes
No
Under what circumstances would you not be able to keep this animal?
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Your answer
Please type your name and date:
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Your answer
A copy of your responses will be emailed to the address you provided.
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