Your Name (required)
Date:
Address (required)
City (required)
State (required)
Zip (required)
Phone (required)
Your Email (required)
Number of adults in your household and relationship to you:
Name and Employer of each adult:

Name, address and phone number of your veterinarian
Two references with names, relationship to you and phone numbers.

Do you rent or own? RentOwn
Length of time at current address:
If you rent - name, address and phone number of landlord:

If you rent - do you have your landlord's permission to have a dog? YesNo
How long do you plan to live at your current address?
Number of children in your household and ages:
Are all the members of your household in agreement with this adoption?
YesNo
Is there a specific pet you are interested in?(Perhaps you saw a dog on our website or facebook page that caught your eye?)

What type of experience do you have with dogs?
First time ownerHave had one or twoKnowledgable & Experienced

Tell us about your current and past pets. Please include pet's name and indicate cat or dog, past or current, male or female, kept inside, outside or both, spayed or neutered, yes or no:

If your pets are not spayed/neutered, why not?
Up to date on vaccinations?YesNo

Have you ever had to give up a pet and if so, why?

Why do you want to adopt a dog?

A dog may life 10-15 years, are you prepared to make a commitment to this dog for its lifetime? YesNo
Under what circumstances would you not keep this dog?
Where will the dog be kept and sleep: inside, outside or both?
If outside what shelter will be provided
How long will your dog be without human companionship? hours/day, days/week

Are you prepared to wait two weeks or longer for your dog to adjust to its new home and become affectionate? YesNo
How much time do you think you will need to devote to grooming a week?
Under 30 Minutes1 HourOver 1 Hour
Are you aware that, in the first year, regular preventative medical attention may cost $150-$200? YesNo
How much money do you expect to spend after the first year on vet care? Under $50$50-$150$150-$200Over $200
Are you aware that, in the first year, food, pet supplies and training may cost $200-$400? YesNo
How much do you expect to spend monthly on food, grooming, toys and accessories?
Under $50$50-$100Over $100
What brand and type of food will you feed?

Please describe what kind of dog you are looking for, age, sex, color, etc
Sex: MaleFemaleNo Preference
Activity Level: LowMediumHighNo Preference
Age: 8-16 weeks4-12 months1-3 yearsOlderNo Preference
Adult Size: 4-20 lbs Small21-45 lbs Medium46-70 lbs Large71+ lbs X-LargeNo Preference
Coat: ShortMediumLongNo Preference
Do you need a dog that will be adaptable to any of these considerations?
ChildrenOther PetsEmpty House During Day/NightBusy HouseholdOther
Are you willing to consider a dog with "special needs" (special diet, disabled, shyness, etc.)?YesNo
Please give us any other information you would like us to know which may help us in finding the best dog for you

Are you wiling to make an adoption donation (adoption fee) to adopt a rescued dog? YesNo
How did you hear about Emmet Co Animal Shelter?
PetfinderOur WebsiteRadio or PaperFamily/FriendsOther

Regrettably, we may not be able to approve an adoption if a particular animal's needs are not compatible with a prospective adopter's profile. The Emmet County Animal Shelter reserves the right to refuse an adoption if the screening volunteer does not feel that the placement is a reasonable match for the animal's needs. All animals remain the property of the Emmet County Animal Shelter until an adoption contract has been completed, with necessary signatures, and the adoption fee has been paid. This screening form is in no way binding nor does it in any way constitute an agreement to adopt or provide adoption.