DOG ADOPTION APPLICATION FINAL - DuPage County, …

1 I am interested in adopting: _____ DOG ADOPTION APPLICATION NAME: _____ DRIVERS LICENSE #: _____ ADDRESS: _____ CITY: _____ ZIP: _____ HOME PHONE: _____ WORK/CELL PHONE: _____ E MAIL: _____ DATE: _____ How did you hear about us? Website Facebook Friend/Family Other: _____ Thank you for considering adopting a pet from our shelter! We will be happy to conduct an animal interaction if/when your APPLICATION has been approved. Remember, you are potentially making a 10 20 year commitment. All dogs have been vaccinated for Canine distemper, bordatella and parvovirus. Your veterinarian may recommend additional vaccinations at the adopter's expense. Puppies often require a series of vaccinations.

2 Dogs over three months of age have been vaccinated for rabies. If your puppy is not already vaccinated for Rabies, you will be provided with a date/time to return for his/her vaccination. All dogs have a microchip as a permanent form of identification, have been spayed or neutered, and tested for Heartworm (if 6 months or older). ADOPTION fees are non refundable. Your adopted pet must be taken to a veterinarian within 7 10 days of ADOPTION for an exam and any necessary vaccinations/medications. You will be provided with a medical/vaccination record at the time of ADOPTION that should be shared with your veterinarian. PLEASE LIST ANY PETS THAT ARE CURRENTLY IN YOUR HOME: OWNED HOW CURRENT ON BREED NAME AGE VETERINARY HOSPITAL LONG?

3 VACCINES? Yes No Yes No Yes No Yes No Yes No PLEASE LIST ANY PETS YOU HAVE OWNED IN THE PAST 5 YEARS: OWNED HOW NOT CURRENTLY IN HOME BREED NAME VETERINARY HOSPITAL LONG? BECAUSE? P a g e 1 | 4 How many people, including yourself, are currently living in your home? _____ Please list the names and ages of the people living your home (include last names if different from yours): 1. _____ Age: _____ 2. _____ Age: _____ 3. _____ Age: _____. 4. _____ Age: _____ 5. _____ Age: _____ 6. _____ Age: _____. Do you live in a single family home, townhouse/condo, or an apartment? _____ Do you own or rent your home? _____ Renters, provide landlord name & number _____. Townhome/condo association name & number _____ PERSONAL BACKGROUND INFORMATION: How long have you lived at your current address?

4 _____ In the last 5 years, how many times have you moved? _____ Do you have a yard? Yes No Is it fenced? Yes No If yes, what is the height of the fence? _____ Describe the activity level in your household? _____ Have you ever given a pet away or relinquished a pet to a shelter? Yes No If yes, please explain: _____ _____ MATCHING THE RIGHT PET: What traits are you looking for in a dog/puppy? (Check all that apply) Playful Housetrained Non Shedding Easy to Train Low Maintenance Non Barking Athletic Other _____ Why do you want to adopt this dog? (Check all that apply) Companion Companion for another animal Gift Guard Dog To teach a child responsibility What will you do with your dog if you move?

5 _____ _____ Where will you keep your animal when you are at home? Inside Outside Basement Garage Other _____ How many hours a day will be the dog be left alone? _____ P a g e 2 | 4 Where will the dog be kept when left alone? _____ How will you exercise your dog? _____ TRAINING: * Please answer these questions to the best of your ability. Any questions you have can be discussed with an ADOPTION counselor. Will you be taking your dog to training classes? Yes No If yes, when/where? _____ How do you plan on housetraining your new dog? _____ _____ What will you do if your new dog develops behavioral problems? ( barking, digging, chewing, jumping, inappropriate elimination) _____ _____ If the dog had a toy, and he growled or snapped at you, how would you respond?

6 _____ _____ If the dog was eating, and he growled or snapped, how would you respond? _____ _____ If the dog refused to obey a command ( get off the sofa) how would you respond? _____ _____ Developing a new routine and bond with your dog may take several months, are you comfortable with this? Yes No Unsure, I would like to discuss this CARING FOR YOUR DOG: Do you already have a Veterinarian? Yes No If yes, what is the name of the hospital/clinic and veterinarian? _____ If no, what is your plan for veterinary care? _____ P a g e 3 | 4 Owning a dog means paying for food, toys, treats, vet care, immunizations and more. A dog can live for 10 20+ years. Are you willing to budget for these expenses for the dog's entire life?

7 Yes No What do you plan to do with your dog when you go out of town? _____ _____ What provisions will you make for your pet(s) if you become unable to care for them? _____ _____ Would you return a dog for any of the following reasons? (Check all that apply) Allergies Marriage/Divorce Dog has medical problems Having a baby Dog isn't house trained Dog has behavior problems Job Change Financial problems Dog has destructive behavior Moving Other, please explain: _____ Tell us why we should adopt a pet to you: _____ _____ Are there any topics you would like to talk about with an ADOPTION counselor? (Check all that apply) Feeding your pet Training What to do if your pet is lost House training Grooming Behavior issue Introducing your new pet to other pets How a microchip works Crating your pet Other: _____ By signing below, I certify that I am 18 years of age or older, the information that I have provided is true and that I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a pet.

8 I authorize DuPage county Animal Care and Control to investigate all statements made in this APPLICATION . I also understand that ADOPTION may be refused at the discretion of the DuPage county Animal Care and Control staff. SIGNATURE: _____ DATE: _____ Once complete, please save and email to: Staff Notes: P a g e 4 | 4