Lakeshore Humane Society

DOG ADOPTION APPLICATION                             

Thank you for your interest in adopting a dog from the Lakeshore Humane Society.   We require that all family members and other family dogs be brought to the shelter to meet the dog you have picked.  Once an animal has been chosen and all family members have been to the shelter to meet the new dog, the processing of your application will take 24-48 hours, because references can be difficult to reach.  Please call the shelter at 920-684-5401 after 48 hours, between the hours of 10am - 7pm,  to check on the progress of your application.   To expedite the process, bring proof of home ownership, or a renters agreement, rabies and vaccination records of current pets with you.  Many things are taken into consideration when placing an animal.  We try to place the animals into the most suitable homes keeping the dog's needs and our family's lifestyle in mind.  Not every dog is suitable for all families.  Should the dog you applied for be placed in another home, please consider another.  We have many wonderful dogs in need of homes. Your application will remain on file for six months.  

PLEASE FILL IN THE QUESTIONS TO THE BEST OF YOUR ABILITY.                                                                                 Thank you.

Just complete this form. Click on Submit when ready to send.


I am interested in:

1st Choice - Dog ID #  Cage # Sex:  MaleFemaleDog’s Name

2nd Choice- Dog ID  # Cage # Sex:  MaleFemaleDog’s Name

E-mail Address

Name (First, MI, Last)

Spouse's/Roommate's Name (First, MI, Last)

Address: Street CityState Zip

Area Code/Home Phone:Area Code/Work Phone:

Employer's Name:

Do you:  Own    Rent your residence

House     Condo    Apartment     Mobile Home     Dorm

If renting please provide landlord's name/phone number:

How many adults in the household?         # Children Children’s ages: 

Do you currently own pets?

LIST CURRENT AND PAST PETS (up to three years ago)

1) Name Breed Age Male/ Neutered        Female / Spayed

Housed: Inside Outside Inside & Outside                     Still Own: Yes No

Vet Records:  Date of RabiesDate of Distemper

2) Name Breed Age Male/ Neutered        Female / Spayed

Housed: Inside Outside Inside & Outside                     Still Own: Yes No

Vet Records:  Date of RabiesDate of Distemper

3) Name Breed Age Male/ Neutered        Female/ Spayed

Housed: Inside Outside Inside & Outside                     Still Own: Yes No

Vet Records:  Date of RabiesDate of Distemper

4) Name Breed Age Male/Neutered              Female/Spayed

Housed: Inside Outside Inside & Outside                     Still Own: Yes No

Vet Records:  Date of RabiesDate of Distemper

If you no longer have the above pet(s), please explain why:

What veterinary clinic do you use?

What is your veterinarian's phone # ?

Are all your pets up-to-date on distemper vaccines and rabies?

What owner's name are the vet records listed under?

Two non-related references that can be reached during the hours of 10:00am - 7:00 pm

Reference Name 1:  Phone

Reference Name 2:  Phone

 

Have you ever applied to adopt or adopted from us before?  Yes No Are you 18 or older?Yes No

Have you ever brought an animal to a shelter?Yes No If yes, why?

Have all of the family members and family dogs been brought in to meet the dog you are applying for?                                       Yes No

Does any member of your family have allergies to pets?Yes No Taking medication?Yes No

It is estimated that it will cost $300-$350 per year to support a pet. Is this an expense you can afford?                                       Yes No

Are you aware of the license and leash laws in your community? Yes No

It may take your new dog a month or longer to adjust to it’s new home. Are you prepared to allow that much time?YesNo

Where will your dog be kept? Inside       Outside (sometimes)     Outside (all the time)

If dog will be outside how will the dog be sheltered or restrained?  Not applicable     Barn     Garage     Kennel    Dog House  Running Cable       Explanation of where kept:

Do you have a fenced in yard?  Yes  No      

If you have a fenced in yard what is the height and type of fence?

How do plan to prevent the following possible behavioral problems:

Barking:           

Digging:           

Chewing:          

House soiling:   

When I am not home this dog will be:  Crated:    Confined to one room:   Run of house: Outside: 

I prefer a dog that is: Very active: Somewhat active: Mellow: Good with children   Good with cats

I would like to adopt this dog for:  Hunting: Protection: Farm dog: For children: Companionship:

Dog experience:  First time dog owner:    Owned dogs:    Experienced/Knowledgeable dog owner:

Household activity level:  Quiet:   Active:   Very active:

Outside visitors:  Very frequently:       Occasionally:       Seldom:

What type of Identification do you plan to place on your dog?

Who will care for your pet when you are away on vacation or business?  Family    Friend     Neighbor                                                                                                           Boarding facility  Professional Pet-sitter                                                                                                            Other:  

Children should not be solely responsible for care of a pet.

Are all family members willing to care for this dog? Yes No

Dogs often live15+ years.  Are you ready to be responsible for this dog for it’s entire life?YesNo

How did you learn about this pet?
Website Friend Shelter Visit NewspaperOther

Any Additional Comments:

I certify that the information 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. I understand that the Lakeshore Humane Society, Inc. has the right to deny my request to adopt an animal and I authorize investigation of all statements in this application.

    I agree to the above statement:            I disagree to the above statement:          

 

 

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