Dog Application – Fort Smith Animal Society

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Order Number

Contact Information

First Name *

Last Name *

Primary Phone *

Alt Phone

Email Address

Address *

City/Town *

Province *

Postal Code *

Your Family

Dog's Name (if known)

Who are you adopting this dog for? *

Have all members of your family been introduced to this dog (including other pets)? *

Is anybody in your home allergic to dogs? *

Number of Adults in Home (18+) *

Number of Children in Home (0-7) *

Number of Children in Home (8-17) *

How busy is your household? *

How would you describe yourself? *

How would you describe the other people in your house? *

Are you planning the following in the next month?

Going on a holiday

Moving to a new home

Change in your schedule

Do you have a veterinarian?

Yes

Not Yet

Please provide name, phone number and details

Your Home

Type of Home *

Do you own or rent? *

Do you have your landlord's permission to have a dog?

Landlord's Name and Phone Number

Do you have a fenced yard? *

Yes

Not Yet

If yes, what is the fence height? *

What will you do with this dog if you have to move? *

Who will be the dog's primary care giver? *

Where will the dog be during the day? *

Where will the dog be at night? *

How many hours per day will your dog spend alone? *

Where will the dog stay when you go on holidays? *

How many dogs have you had in the past 5 years? *

What happened to them?

Other Pets

Do you have other dogs? *

How are they towards other dogs?

Type/Breed

Are they spayed/neutered?

Do you have cats or other animals? *

How are they towards dogs?

Type/Breed

Desired Dog Characteristics

Gender

Age

Breed

Please give us any other information that might be important to help us make a better match.

For what reasons would you like to adopt this dog?

Companion

Guard

Hunting

Obedience

Agility

Other

Problems you are willing to tolerate and work on:

Barking

Chewing

Separation Anxiety

House Breaking Problems

Jumping Up

Shedding

Digging

Property Damage

Digging

Check all that apply

How will you resolve these issues?

How much time and thought have you put into welcoming a new pet into your home?

What do you feel are the most important responsibilities in owning a dog?

I would like my cat to:

Have you ever surrendered a pet to the FSAS or other organization? *

Yes

If yes, please indicate the reasons.

Are you aware of the existing bylaws that pertain to animals in your community? *

Yes

Not Yet

Have you made arrangements to spend a few days with this animal as it becomes accustomed to its new environment?

Yes

If no, why not?

Under what conditions would you return your dog?

Aggressive

Moving

Divorce

Not Getting Along With Other Pets

Too Costly

Retiring

Sick Dog

New Baby

Vacation

Allergies

Check all that apply

Disclaimers

Disclaimer:

I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adoption. This dog will reside in my home as a companion. I will provide him/her with adequate food, water, shelter, training, affection and medical
care. All of the information I have given above is true and complete. I am in full agreement with the Fort Smith Animal Society terms of adoption. The Fort Smith Animal Society is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household.

Falsified information will lead to automatic rejection of the application -We reserve the right to refuse any applicant

Please check to acknowledge. *

I have read and acknowledge this disclaimer.

Have you ever been convicted of neglect or cruelty to animals? *

Yes

Are you willing to have a Fort Smith Animal Society or other SPCA representative do a home visit by appointment? *

Yes

If no, why not?