Adoption Questionnaire - Dog 
Adopting a pet is a lifelong commitment, please consider the future expenses associated with adopting a cat. This questionnaire is intended as a tool to determine the best fit for the animal. Manistee County Humane Society (MCHS) reserves the right to review multiple applications prior to adoption, or to decline an application for any reason. Applicants must be 18 years of age. 
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Dog of Interest
Name of Applicant (First and Last) *
 Home Address
Please include: city, state, zip code *
Phone Number
Email Address
Date of Birth of Applicant *
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Do you RENT or OWN your home? (other, i.e. live with family member) *
If you rent, provide the name and phone number of your landlord: 
List the name, age and relation of all members of the household:  *
If your were to have to move, what would you do with your new pet? (consider changes to job, living situation, finances) *
Does any member of your household have pet related allergies? *
List all other pets in the home (type/age/breed): *
Are any of the pets intact? *
List previous pets for the last 5yrs (type/age/breed/where are they currently? i.e. passed, rehomed): *
Name of current or past Veterinarian:
(include phone number, and name of account holder if different from the applicant)  *
How will your dog be cared for during vacations/emergencies:  *
Are you committed to continuing preventative care, like vaccinations:  *
Are you financially capable of providing care for this pet in the event of illness? *
What is the maximum amount (to care for illness), if limited:  *
Do you have someone to care for your pet if something happens to you?: *
How would you describe your household activity level:  *
Brief description of schedule in the household, how much time spent at home vs. away: *
Where do you intend for this dog to spend its time:  *
Do you have a fenced yard? *
If no, how do you intend to keep your dog safe & close to home? *
How do you plan to provide adequate exercise & stimulation for your new pet: *
Where will the dog be kept when home alone? *
What qualities are you looking for in a dog? (Check all that apply) *
Required
What issues/behaviors are you willing to train/work on with your adoptive dog? (check all that apply) *
Required
If behavioral challenges arise, how will you handle/work on them: *
If necessary, are you willing to attend obedience classes at your own cost? *
What behavioral challenges would cause your to surrender your dog?
Have your ever surrendered or rehomed a pet? *
If yes, please elaborate: 

BY SIGNING THIS APPLICATION (TYPING FIRST AND LAST NAME BELOW), YOU UNDERSTAND AND AGREE THAT A REPRESENTATIVE FROM MCHS HAS THE RIGHT TO DO A HOME VISIT PRIOR TO AND/OR AS A FOLLOW UP TO ADOPTION.

I certify the above information in this application is true, and understand that any false information or omission may result in the denial of this application or nullification of a completed adoption resulting in the return of said animal.

I give MCHS permission to follow up on all provided information provided and will reach out to a landlord if applicable, and a vet reference. 

The submission of this application does not indicate approval for adoption. A representative from MCHS will follow up by phone or email, as quickly as possible. 

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Today's Date *
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