Danville-Boyle County Humane Society's Mutts with Manners Adoption Application

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Thank you for choosing adoption! Please complete the following questions to help guide our conversation.

Email *

Name of desired dog? *

Your full name *

Street Address *

City, State and Zip Code *

Cell Phone *

Number of residents in your home and their ages *

Do you rent or own your home? *

Rent*

Own

*If you rent, please provide landlord name and phone number

Tell us about pets at home: *

We have one or more dog(s)

We have one or more cat(s)

We have one or more small animal(s)

I’d like help with introducing a new pet to pet(s) at home

We have no pets.

Required

List breeds and ages of current dogs *

Please tell us about the pets you have had in the last 5 years (age, sex, breeds) *

Who will be the primary caregiver of the adopted pet? *

How long will the pet be left unattended on an average day? *

Where will the pet serve most of their time? *

Indoors

Outdoors

If outdoors, do you have a *

fenced yard

kennel

unfenced yard

invisible fence type enclosure

Other:

Required

We’ll explain this new pet’s medical history and behavioral history. Check additional topics you’d like to discuss:

Feeding this pet

House-training/litter box training

Grooming/nail trimming

Exercise, toys and fun activities

Puppy/kitten-proofing your home

Introducing this pet to other pets

Finding a veterinarian

Crate-training

Pulling on-leash

Flea/tick prevention

Heartworm prevention

If you have a veterinarian, please list below *

Are you willing to continue training following adoption? *

Yes

Have you ever surrendered a dog before?

Yes

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Adoption Statement:

Initial each statement below

I agree to provide proper care, including routine veterinary care, daily exercise and proper diet for the animal I am adopting from Danville-Boyle County Humane Society. I will abide by any ordinances governing pet responsibility. *

Common conditions that may need to be treated after your pet leaves the shelter include parasites such as worms, coccidia, fleas or ear mites. Bordetella (kennel cough) and skin problems can also occur. I realize no refund will be given for vet expenses I may incur following adoption. *

If for any reason the Adopter is unable to provide care to the animal, the Adopter agrees to return the animal to DBCHS. The Adopter shall not offer the animal for sale or give the animal to any third party without the prior written consent of DBCHS. No refund will be given. *

The Adopter agrees that DBCHS shall have the right of immediate possession of the animal if, in the judgment of DBCHS, the animal is receiving inadequate care, is being improperly housed or handled or is placed in any immediate danger. *

The Adopter represents that he/she has never been subject to legal action for cruelty to or neglect of animals. The Adopter further represents that he/she has never owned an animal which has been confiscated by any animal control or humane organization for violations of state or local animal control regulations or animal adoption agreements. *

The Adopter grants DBCHS the right to make periodic visits to the Adopter’s premises for the purpose of checking on the health and general welfare of the animal. *

I certify that the information I have provided is true and understand that any false information could nullify the adoption. Danville-Boyle County Humane Society reserves the right to refuse any adoption. *

Send me a copy of my responses.

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