Guernsey County Dog Shelter Pre-adoption Application
Adoptable dog's name and code # *
Adopter's name *
Address *
Home phone *
Alternate phone *
Email address *
Are you 18 years of age or older? * yes no
How did you find us?
Place of employment? *
How long at your current residence? Do you rent or own? *
landlord's name and phone #
Are you adopting this pet for your own household? * yes no
If not,explain
Number of adults in household *
Number of children in household *
Does everyone in this household want this pet? * yes no
Any pet allergies? * yes no
Have you owned a dog before? * yes no
If so, what breed?
What happened to the dog?
List species and number of pets you currently own *
Do you breed any pets or plan to breed this adoptable pet? * yes no
Of pets listed, how many have been spayed/neutered?
List name and phone # of your veterinarian (leave blank if n/a)
Is your dog currently licensed? yes no
Is the tag worn on collar? yes no
Do you understand what is involved in housebreaking a pet? * yes no
Will this dog live indoors, outdoors or both? *
How many hours per day will this dog be left alone? *
Where will the pet stay when you are gone? *
What outdoor space is available: fenced, unfenced yard, kennel? *
If unfenced, how will you confine/control this dog?
If kept outdoors, what type of shelter is available?
Where will this dog sleep at night? *
Do you plan to use a crate? * yes no
Primary reason for wanting to adopt this dog *
Ever accused/convicted of animal cruelty/neglect? * yes no
If yes, explain
Ever accused/convicted of crime relating to animals? * yes no
If yes, explain
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