Dog Adoption Application - Capital Area Humane Society
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1Dog
Adoption Application
Thank you for your interest in adopting from the Capital Area Humane Society! We are excited to help you find
an animal to join your family. Please take a moment to complete the following information and return this form to
an Adoptions Counselor or matchmaker volunteer when you are finished.
Name: ________________________________________________ Date: ____________________________
First
Last
Address: _________________________________________________________________________________
Street
City
State
Zip
Home Phone: _________________________________
Alternate Phone: ____________________________
Best Time to Phone You: ________________________
Email Address: _____________________________
Dog’s Name: ___________________________
ID # _________________________________
Do you own or rent your home?
OWN
RENT
Please provide the name & phone for your landlord: _________________________________________
Have you had a dog before? When and for how long? _____________________________________________
How many adults and children currently live in your home?
______ Adults
______ Children
Does anyone in your home have allergies to dogs?
YES
NO
Who will be primarily responsible for caring for this dog? ___________________________________________
How many and what kinds of pets are currently in your home? Please list them.
_________________________________________________________________________________________
_________________________________________________________________________________________
How often will you plan to take your dog to the vet? _______________________________________________
Where will your new dog primarily live? (circle one)
INDOOR ONLY
INDOOR / OUTDOOR
OUTDOOR ONLY
Daily, your dog will need to be alone…(circle one)
LESS THAN 8 HRS.
8-10 HRS.
MORE THAN 10 HRS.
When you are not home, your dog will be… (circle one)
CONFINED TO A ROOM IN HOUSE
IN A CRATE
LOOSE IN THE HOUSE
YARD/ GARAGE
Please list an alternate contact for your dog’s microchip registration:
Name: _______________________________
Phone: _____________________________
Rev. 10.2009
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