McCook Humane Society's Dog Adoption Form
YOUR NAME
*
First Name
Last Name
Email
example@example.com
NAME OF DOG
*
ARE YOU OVER 21 YEARS OF AGE?
*
YES
NO
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOW LONG AT THIS ADDRESS?
*
DAYTIME PHONE
*
EVENING PHONE
*
OWN YOUR HOME?
*
RENT? (if yes, you must have landlord approval)
*
IS YOUR YARD FENCED?
*
YES
NO
HOW WILL YOUR DOG BE EXERCISED?
*
HOW OFTEN?
*
WHERE WILL HE SPEND THE DAY?
*
WHERE WILL HE SPEND THE NIGHT?
*
IF OUTSIDE, DO YOU HAVE SHELTER AVAILABLE FOR HIM?
*
YES
NO
HAVE YOU OWNED PETS IN THE PAST 3 YEARS?
*
YES
NO
IF YES, WHAT HAPPENED TO THEM?
*
WHAT ANIMALS DO YOU OWN NOW?
*
ARE THEY SPAYED OR NEUTERED?
*
YES
NO
IF NO, PLEASE EXPLAIN:
*
IF YOU OWN OTHER DOGS OR CATS ARE THEY CURRENT ON VACCINATIONS?
*
YES
NO
WHAT IS THE NAME & PHONE # OF YOUR VETERINARIAN?
*
ARE THERE CHILDREN IN THE FAMILY?
*
YES
NO
IF YES, WHAT ARE THEIR AGES?
*
ARE YOU FINANCIALLY PREPARED TO PROVIDE THE NECESSARY CARE FOR YOUR PET: INCLUDING PROPER FOOD, VACCINATIONS, PARASITE CONTROL (FLEAS, TICKS, WORMS, ETC.) ADEQUATE SHELTER, AND VETERINARY CARE FOR YEARLY CHECK-UPS AND MEDICAL EMERGENCIES?
*
YES
NO
HAVE YOU EVER PLACED A PET IN AN ANIMAL SHELTER?
*
YES
NO
IF YES, WHAT WAS THE REASON?
*
BY TYPING MY FULL NAME BELOW, I AFFIRM THAT ALL INFORMATION ABOVE IS TRUE. I REALIZE THAT THIS IS A LIFETIME COMMITMENT AND WILL ENDEAVOR TO GIVE THIS PET A HAPPY AND HEALTHY HOME. IF THERE ARE PROBLEMS WITH THIS PET OR I MUST GIVE HIM UP I WILL CONTACT THE MCCOOK HUMANE SOCIETY.
*
TYPE FULL NAME HERE
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*
Submit
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