Dog Adoption Application
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1
2For Office Use Only: Dog ______________________ Status ____________________ Yard Check________
Landlord Check_________ Vet Check___________ Requirements___________________________________
Dog Adoption Form: The Humane Society of Greater Kansas City
Welcome! We request the following information and a consultation with an adoption counselor to help you find a dog with the qualities you’d
like and who matches your lifestyle. To be considered as an adopter, you must: Be 21 years of age • Have the knowledge and consent of
all adults living in your household • Have a valid ID with current address • Have the knowledge and consent of your landlord • Understand that
The Humane Society of Greater Kansas City must approve your application (based on the policies set by the board of directors.)
Name:_______________________________________________________ Email:_________________________________________
Address:_____________________________________________ City/State/Zip:___________________________________________
Best Phone# to reach you:_________________________________ Second Phone #:______________________________________
1.
Your age:_______ Please list the names and ages of all other adults and children living in your home:_____________________
______________________________________________________________________________________
2.
Where do you live? (circle)
House
Apartment
Condo
Duplex
Mobile
Other:_________________________
Do you: Rent
Own
Live with parents
Landlord’s name:________________________________________________Phone:____________________________
What is your landlord’s pet policy, and is a deposit or rent increase required? __________________________________
3.
Are there any persons who regularly visit the home (grandchildren, family members, etc)? If so, please explain and list their ages:
______________________________________________________________________________________________________
Any dogs or cats who visit regularly? No____ Yes, please explain:_______________________________________
4.
Is anyone in your home allergic to dogs? No____ Yes, please explain:____________________________________
5.
What pets do you currently have?
Pet’s Name
Type/Breed
Inside or Outside Pet
Age
Sex
Spay/Neutered
Yes
No
Yes
No
Yes
No
Yes
No
What pets have you had in the past 10 years but no longer have?
Pet’s Name
Type/Breed
Inside or Out
Age
Reason no longer with you
Spay/Neutered
Yes
No
Yes
No
Yes
No
Yes
No
6.
Do you vaccinate annually? Yes___ No____ Other:_________________________________________________
Do you give your dogs heartworm preventative? Yes (list brand name):___________________ No____
Not sure_____ N/A____
I need more information about heartworms and heartworm preventative_______
7.
Who is/was your veterinarian for the above pets?____________________________________ Phone:________________________
8.
Are you interested in adopting a particular dog? If yes, name of dog: ____________________________________
9.
What type of dog are you looking for? (circle all that you’d be interested in)
Male
Female
Puppy
Adult
Senior
Small (up to 20 lbs)
Medium (20 to 40 lbs)
Large (40 and up)
One with Special Needs: Medical or Behavioral
Particular Breed:__________________________________________
10.
Why would you like to adopt a dog? (circle all that apply)
Companionship
Friend for my pet
For the kids
Gift
Hunting
Breeding
Outside guard dog
Inside family protection
Other:___________________________________
11.
What qualities and behaviors are you looking for in your new dog?___________________________________________________
________________________________________________________________________________________________________
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