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Dog Adoption Form

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Adopter Information
Adopter Name*
First Last
Date of Birth*
Month
Day
Year
Spouse or Co-Applicant Name
First Last
Spouse or Co-Applicant Date of Birth
Month
Day
Year
Street Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address
Street Address City State ZIP Code
Email*
Home Phone*
Cell Phone*
Applicant Employer
Spouse or Co-applicant Employer

Household Info
Home Ownership
- Own
- Rent
- Other
Residence Type
Homeowner Name
First Last
Homeowner Phone
Landlord Name
First Last
Landlord Phone
Do all adults in your household know that you plan to adopt?
- Yes
- No
Number of Adults in Home
Number and ages of children in home
What type(s) of pet(s) have you owned during the past five years?
Type/Breed Age Name Spayed/Neutered? (Yes/No) Still Own? (Yes/No)
If you have a veterinarian, please provide his/her name and the clinic name.
I have owned a dog before:
- Yes
- No
The last time I had a dog was:
My dog needs to get along with my other dogs:
- Yes
- No
If yes, list their names, ages, genders and breeds (if other than animals listed above):
Name Age Gender Breed
My dog needs to be good with (check all that apply):
- Children over 8 years old
- Children under 8 years old
- Elderly people
- Cats
- Animals other than cats and dogs

Info that will help find the right dog for adopter.
My dog will primarily be an:
- Inside Dog
- Outside Dog
How many hours will your dog spend outside per day:
My dog needs to be able to be alone:
When I'm at home, I want my dog to be able to be by my side:
When I'm not at home, my dog will spend his time:
I want a guard dog:
- Yes
- No
I want my dog to hunt or herd with me:
- Yes
- No
I want my dog to be the type that is very enthusiastic in the way s/he shows s/he loves people:
I plan to exercise my dog by:
I would describe my household environment as:
I expect my dog to be:
I want my dog to be playful:
I want my dog to be laid back:
I am comfortable doing some training with my dog to improve manners such as jumping, stealing food and pulling on the leash:
I (or my children) want to compete in Agility, Flyball or Obedience with our dog:
- Yes
- No
I would consider a dog with "special needs" (medical or behavioral):
- Yes
- No
I am willing to attend an obedience or socialization course with my dog:
How often do you plan to take your dog to the veterinarian:
How much do you think you'll spend yearly for the care of your dog? (Food, medical care, boarding, toys, etc.):
If I can no longer keep my dog I will:
I plan to give my dog ___________ to adjust to my house and family:
If I have adjustment issues with my dog I will:
Name of Animal Interested in Adopting
Please tell us why you are interested in adopting this animal and why you feel they would be a good fit for your family.
Please share with us any additional information you would like concerning your family and the dog you would like to adopt.

Terms & Conditions
I certify that I am at least 18 years of age and the information I have given is true. I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a companion animal and I understand that the Lakeland Animal Shelter has the right to deny my application.

I am fully aware that I am adopting a living creature and as such that the Lakeland Animal Shelter is unable to guarantee the health of the animal.

If this animal becomes ill, I certify that I am financially and/or emotionally prepared to treat this animal at my own expense.
I have read and agree to the terms and conditions.*
- Agree
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

3615 State Road 67
Delavan, WI
P.O. Box 1000
Elkhorn, WI 53121
(262) 723-1000
(262) 723-1001
Mon - Fri: 12PM - 5PM
Sat: 11AM - 4PM

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/ Wisconsin Dog Seller's Permit #268467-DS
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