ANIMAL PROTECTION SOCIETY – FRIDAY HARBOR

111 Shelter Road PO Box 1355 Friday Harbor, WA 98250

(360) 378-2158

pets2homes@interisland.net www.apsfh.org

ADOPTION APPLICATION – DOG / PUPPY

TO ENSURE THAT THIS ADOPTION IS IN THE BEST INTEREST OF BOTH YOU AND THE ANIMAL YOU SELECT, WE ASK THAT YOU ANSWER THE FOLLOWING QUESTIONS. THOUGH IT MAY TAKE YOU SOME TIME TO COMPLETE, PLEASE BEAR IN MIND THAT YOU ARE CONSIDERING MAKING A COMMITMENT TO FEED, SHELTER, PROTECT AND LOVE AN ANIMAL FOR THE REST OF ITS LIFE!

NAME:____________________________________________________ DATE_____________________

PHYSICAL ADDRESS____________________________________________________________________

MAILING ADDRESS:____________________________________________________________________

HOME PHONE:_______________________________WORK PHONE:___________________________

EMAIL ADDRESS_______________________________________________________________________

Please list the names of all your household members and their ages, if under 18:

____________________________________________ ___________________________________________

____________________________________________ __________________________________________

Do you rent or own your home?_____________________Landlord’s name__________________________

(We must OK any adoption with landlord) Landlord’s phone_________________________

Do you have outdoor confinement or this dog? Yes_______ No________

Describe________________________________________________________________________________

Under what circumstances would you give up this pet?__________________________________________

Have you ever given up ownership of a pet? _____________If yes, please explain:___________________

Please list pets you have now or pets you have had in the past 3 years:

Species Breed Age Altered? Length of Ownership

DOG ADOPTION CONTRACT

I agree to the following requirements related to the adoption of my new dog or puppy:

I WILL TAKE CARE OF THIS DOG FOR ITS LIFETIME. IF I BECOME UNABLE TO CARE FOR THIS ANIMAL, I WILL FIND IT A GOOD HOME OR RETURN IT TO AN ANIMAL SHELTER. I WILL NOT ABANDON IT.

I WILL PROVIDE THIS DOG WITH MEDICAL CARE AND ANNUAL IMMUNIZATIONS AS NEEDED.

I WILL PROTECT THIS DOG BY PURCHASING A COUNTY LICENSE AT TIME OF ADOPTION AND YEARLY THEREAFTER. (MANDATORY IF LIVING IN S J COUNTY.)

I WILL PROVIDE THIS DOG WIH PROPER FOOD, FRESH WATER, ADEQUATE SHELTER, EXERCISE, TRAINING AND KIND TREATMENT AT ALL TIMES.

I WILL RETURN THIS DOG TO THE SHELTER WITHIN 7 DAYS IF A VETERINARIAN HAS DETERMINED THIS DOG IS ILL, OR IF THIS DOG IS NOT COMPATIBLE WITH OUR FAMILY SITUATION.

I ACCEPT FULL RESPONSIBILITY FOR ANY RISKS ASSOCIATED WITH THE OWNERSHIP OF THIS PET.

_______________________________ _________________________________

DATE SIGNATURE

__________________________________

STAFF SIGNATURE__________________________ PRINT NAME

APS FILE #___________________________ __________________________________

ADDRESS

DOG NAME:___________________________

__________________________________

PAYMENT DUE:_______________________

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DEPOSIT__________PD IN FULL_________ HOME PHONE WORK PHONE

CASH_______CHECK___________DATE__________