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Humane Society of Knox County Canine Adoption Application 400 Columbus Rd. Mount Vernon, OH 43050
Animal
Name/# ________________________ (740) 392-2287 http://www.knoxhumanesociety.org
Date
________________________________ You must be at least 18
years old to adopt. There will be
at least a 24-hour waiting period to allow us to process your application,
contact references and landlord (if applicable), and for you to carefully consider
your decision to adopt a dog for life.
A home visit is also required.
The Humane Society of Knox County (HSKC) may refuse an application for
any reason.
Name:
___________________________________ Spouse's
Name: _________________________
Address:
_____________________________________________ City, State, Zip _______________
Home
phone: ______________ Work phone:
______________ Email:
_______________________
Length
of time at address: _________________ Driver's
License # ________________________
Occupation:
________________________ Employer:
___________________________________
Current
home: ___ Own ___ Rent (Circle one: House, Apartment, Mobile Home,
Condo)
Name
of Landlord (if applicable): _____________________________ Phone: __________________
What
type of animal are you looking for? ___ Companion ___ Guard Dog ___ Hunting Dog
On a
scale of 1-5 (with 5 being highly energetic and 1 being very quiet) what
activity level are you looking for?
Why
have you chosen to adopt this animal?
______________________________________________
Do all
household members agree to this adoption? __________________________________________
List
all household members (include ages of children):
Who
will have primary responsibility for the daily care of this animal?
Do
any household members have allergies?
If
so, to what?
List
all current pets:
Type
of Animal Male/Female Spayed/Neutered Licensed Inside/Outside
Who
is your veterinarian? ____________________________________ Phone:
________________ We will be calling your
veterinarian for a reference.
Please contact your veterinarian,
How
will you introduce this animal to your current pets?
_______________________________________
Where
will this animal spend most of its time?
_______________________________________________
Do
you have a fenced yard?
___________________________________________________________
If
no, what will you do for the animal's exercise and elimination requirements?
Where
will this animal sleep?
How
many hours will this animal be left alone in a 24-hour period?
______________________________
How
will you confine or care for this animal when no one is home?
______________________________
Do
you realize that this animal may not be housetrained?
______________________________________
What
techniques would you use for housetraining?
___________________________________________
Do
you realize that this animal may chew (shoes, furniture, etc.)? ______________________________
How
would you prevent/correct this behavior?
_______________________________________________
How
long will you allow this animal to fully adjust to his/her new home? ___________________________
What
do you like to do in your spare time?
__________________________________________________
If
you go on vacation, what will you do with this animal? _______________________________________
Will
having children, now or in the future, affect your commitment to keeping and
caring for this animal?
____________________________________________________________________________________
Have
you ever surrendered an animal to a shelter? If so, what was the reason?
What
in your opinion would constitute prime reasons for giving up an animal?
How
did you hear about our Canine Program?
I acknowledge that all
information on this application is correct. I grant HSKC permission to
____________________________________
________________________________
Applicant
Signature HSKC
Representative Signature |