AMHS - Canine Pre-Adoption Application Animal # ________ Contract # _________

Please complete this form prior to the adoption of a cat or kitten. This information will help AMHS achieve its goal of finding permanent, responsible, loving homes for the animals in its care and allow AMHS better assist you in finding a pet well suited for your needs.

Animal Interested In  ________________________________________

Name____________________________________________________  Birthday ___/___/_____

Address__________________________________________________  Driver's License # ____________________

City ________________________ State___________ Zip_________

Home Phone #______________________________  E-mail Address _____________________________________

Why do you want to adopt this pet?_______________________________________________________________ __________

Please list the pets you currently own and/or are living at your residence:

Type of Pet            Name              Age            Sex            Spayed/Neutered?            How Long Owned?

______________________________________________________________________ _________________________

______________________________________________________________________ _________________________

______________________________________________________________________ _________________________

Please list the pets you have previously owned (in the last 5 years):

Type of Pet                Name               How Long Owned?                Where is this Pet now?

______________________________________________________________________ _________________________

______________________________________________________________________ _________________________

______________________________________________________________________ _________________________

Will young children be living with this new pet? Yes No If Yes, how many? ______________

If Yes, what are the children's ages. __________________________________________________________________

Have these children been around dogs before? Yes No

Are you prepared to supervise your children when they interact with this dog? Yes No

Other adults (Name, Age, Relationship to you):
1.)_____________________________________________________ 
2.)_____________________________________________________
3.)_____________________________________________________

Check one:  Do you (   ) Own your home (   ) Rent (   ) Live with your parents

Is your Home:   (   ) House   (   ) Apartment   (   ) Condo/Duplex    (   ) Trailer Home

Is Your Home:   (   ) Residential   (   ) Rural

If you live in a rental property, does your lease allow dogs?   Yes   No

Landlord's Name _____________________________________________ Phone # __________________________

If you live with your parents, please provide their contact information.

Parent #1:  Name _______________________________________  Phone # __________________________
Parent #2:  Name _______________________________________  Phone # __________________________

Will you be moving soon? Yes No If yes, what are your plans for this pet? _____________________________

(Circle One)  Is your household:        Active        Noisy        Quiet        Average

Where will this dog spend most of its time? Indoors Outdoors In & Out

How much time will this dog spend outdoors? ____________

When outdoors, how do you plan to keep this dog confined to your property to prevent injury?__________________________________________________________________ _

What outdoor shelter will be provided? _____________________

Have you adopted from our shelter before?_______  If so, when? _________________

Have you surrendered a pet to our shelter before?_____  If so, when? ______________   Reason:______________

Is anyone in your home allergic to dogs? Yes No Not Sure

Veterinary care, grooming, emergency expenses, supplies and food for a dog's lifetime can often add up to hundreds of dollars each year. Are you prepared to afford this care? Yes No

Which Veterinarian do you currently use? _______________________________
Clinic Name________________________________________  Phone # _____________________

Will you continue to use this vet?________  If not, why?_____________________________________________

Dogs can live longer than 12 years. Are you prepared to take responsibility for this dog's entire life? Yes No

All dogs making the transition from shelter to a new home need time to adjust to a new family and may require housetraining and behavior training to correct problem behavior. Are you prepared to housetrain this dog and provide obedience training if necessary? Yes No

Information regarding the history, health and behavior of adopted animals may not be available or accurate. Are you willing to work through any unforeseen difficulties in these areas? Yes No

Because so may shelter dogs have unknown medical histories, AMHS recommends you do not immediately expose your existing pets to your newly adopted pet. Discuss with your veterinarian the advisability of a quarantine period.

Are your other pets current on vaccinations?   Yes   No   NA

You can greatly decrease the time needed to complete an adoption by reading and understanding the following adoption policies now. After reading each item, place your initials in the space provided next to the item.

______ General Physical Examination -- All of the animals have been given a general physical examination including initial vaccinations (excluding rabies) and, if necessary, initial treatments for internal and external parasites. Follow-up medical work is usually needed and should be discussed with the pet's veterinarian at the earliest opportunity. AMHS is unable to provide routine testing for viruses such as feline leukemia, FIP or FIV.

______ Free Physical Examination -- AMHS encourages you to take your new pet to a participating veterinarian within the next seven (7) days for a free follow-up exam. This exam does not include tests, x-rays or other medical treatment. A list of these vets will be given to you at the time of adoption.

______ Animal Return Policy -- AMHS urges you to choose carefully when adopting a pet and to be ready to make a commitment to this animal. Adjustment to a new home can often take more than 7 days for both pet and adopter. If a Veterinarian discovers an ailment or illness at the Free Exam, within 7 days of adoption, the animal may be returned to AMHS for a full refund. All other return requests and refunds are at the discretion of the Shelter Manager.

The undersigned applicant hereby grants AMHS permission to confirm any information provided in this application with any appropriate third party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by AMHS for purposes of this adoption application.

I certify that all the information on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application my be rejected. I also understand that this adoption application is the sold property of AMHS.

It is specifically understood that AMHS reserves the right to deny my adoption application at its own discretion.

Signature________________________________________________ Date_______________________