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Danville-Boyle County Humane Society's Mutts with Manners Adoption Application
Thank you for choosing adoption! Please complete the following questions to help guide our conversation.
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Option 1
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Name of desired dog?
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Your answer
Your full name
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Your answer
Street Address
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Your answer
City, State and Zip Code
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Your answer
Cell Phone
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Your answer
Number of residents in your home and their ages
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Your answer
Do you rent or own your home?
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Rent*
Own
*If you rent, please provide landlord name and phone number
Your answer
Tell us about pets at home:
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We have one or more dog(s)
We have one or more cat(s)
We have one or more small animal(s)
I’d like help with introducing a new pet to pet(s) at home
We have no pets.
Required
List breeds and ages of current dogs
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Your answer
Please tell us about the pets you have had in the last 5 years (age, sex, breeds)
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Your answer
Who will be the primary caregiver of the adopted pet?
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Your answer
How long will the pet be left unattended on an average day?
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Choose
I work from home or am home much of the day
1-4 hours
4-8 hours
More than 8 hours
Where will the pet serve most of their time?
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Indoors
Outdoors
If outdoors, do you have a
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fenced yard
kennel
unfenced yard
invisible fence type enclosure
Other:
Required
We’ll explain this new pet’s medical history and behavioral history. Check additional topics you’d like to discuss:
Feeding this pet
House-training/litter box training
Grooming/nail trimming
Exercise, toys and fun activities
Puppy/kitten-proofing your home
Introducing this pet to other pets
Finding a veterinarian
Crate-training
Pulling on-leash
Flea/tick prevention
Heartworm prevention
If you have a veterinarian, please list below
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Your answer
Are you willing to continue training following adoption?
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Yes
No
Have you ever surrendered a dog before?
Yes
No
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Adoption Statement:
Initial each statement below
I agree to provide proper care, including routine veterinary care, daily exercise and proper diet for the animal I am adopting from Danville-Boyle County Humane Society. I will abide by any ordinances governing pet responsibility.
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Your answer
Common conditions that may need to be treated after your pet leaves the shelter include parasites such as worms, coccidia, fleas or ear mites. Bordetella (kennel cough) and skin problems can also occur. I realize no refund will be given for vet expenses I may incur following adoption.
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Your answer
If for any reason the Adopter is unable to provide care to the animal, the Adopter agrees to return the animal to DBCHS. The Adopter shall not offer the animal for sale or give the animal to any third party without the prior written consent of DBCHS. No refund will be given.
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Your answer
The Adopter agrees that DBCHS shall have the right of immediate possession of the animal if, in the judgment of DBCHS, the animal is receiving inadequate care, is being improperly housed or handled or is placed in any immediate danger.
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Your answer
The Adopter represents that he/she has never been subject to legal action for cruelty to or neglect of animals. The Adopter further represents that he/she has never owned an animal which has been confiscated by any animal control or humane organization for violations of state or local animal control regulations or animal adoption agreements.
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Your answer
The Adopter grants DBCHS the right to make periodic visits to the Adopter’s premises for the purpose of checking on the health and general welfare of the animal.
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Your answer
I certify that the information I have provided is true and understand that any false information could nullify the adoption. Danville-Boyle County Humane Society reserves the right to refuse any adoption.
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Your answer
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