Dog Information (if you have a specific dog in mind) Dog Name/Description Your Information Is your home near a busy highway or road? * Home Phone * Cell Phone Email * Description of Residence Property Owner's Name Property Owner's Phone Number How long have you lived here? What is the number of adults in the household? What is the number of children in the household? What are the children's ages? What pets do you CURRENTLY have in your household? (Describe species, spayed/neutered, where kept, time owned, and age) *** Include names (required for vet check) *** What pets have you PREVIOUSLY had? (Describe species, spayed/neutered, where kept, time owned, and what happened to the pet) *** Include names (required for vet check) *** Veterinarian Reference
*** All fields required; put N/A if it does not apply. ***
What is the name of your veterinarian? * Veterinarian's Phone Number * Important! Is the vet reference under another name? If so, name and reason: * How long have you used this Vet? * Important! Does this vet do everything for your pet or do you use other resources such as CARA-VAN? If yes, explain: * Dog Care Who will be responsible for the daily care/feeding of this dog? Who will financially support this dog? Reason for wanting this dog? Where will you keep this dog? Do all members of this household WANT this dog? If you have young children, they need to be educated on how to interact with the dog in order to prevent dog bites, are you able/willing to do that? How many hours will your dog spend alone? If you must give up this dog, what would you do with it? Would you object to a follow-up home visit by the Darlington County Humane Society? Best day/time: What amount of time will the dog be inside? outside? If adopting an outside dog, do you have a doghouse? If adopting an outside dog, do you have a fenced yard? Height of fence? If adopting an outside dog, do you have a shaded area? Do you plan to chain your dog outside? * Do you realize that an outside dog may entertain itself by digging, chewing home items and/or escaping and wandering? What will you do if your dog shows destructive behavior? (Digging, chewing, jumping, tearing up plants/furniture or running off) Do you realize that you will probably have to housetrain your new puppy/dog? Would you like information on how to housetrain a new puppy or dog? If adopting an adult dog, how many times per day will you exercise it? What form of exercise will you provide for your dog? Will you have this dog vaccinated annually, by a veterinarian, against infectious disease? Are you familiar with heartworm disease? Will you maintain your dog on heartworm preventative? Do you realize that dogs often live longer than 10 years and are you willing to assume responsibility for that long? How will you keep the dog confined to your property? (Check all that apply) Where did you hear about the Darlington County Animal Shelter? Have you applied to adopt from this shelter before today? If yes, what date? Adopted? Where is this animal now? References Reference #1 Name Reference #1 Phone Number Reference #1 Relationship Reference #2 Name Reference #2 Phone Number Reference #2 Relationship Additional Information/Comments Is there any additional information that would be helpful in processing your application? Records Release Please type your full name in the box below as your electronic signature, indicating that you consent to the release of your records from the veterinarian(s) listed above, for the purpose of conducting a veterinarian reference check as part of the evaluation of this application. (Most veterinarians require a release) Certification
By clicking submit, I certify the above is true and that false information may result in nullifying this adoption. I understand that Darlington County Humane Society will verify my references provided above and it may take up to 96 hours for verifications to be completed and for me to be notified of the decision. I also understand that Darlington County Humane Society has the right to refuse adoption to anyone. I understand that no animal can be held for me. I also understand that if for ANY reason, I can’t keep the animal adopted from the Darlington County Humane Society, I will return it to the shelter. I understand that I am prohibited from re-homing the animal to anyone and I must return the animal to the shelter if I can’t continue to keep and care for the animal.