Dog Adoption Form :: Adopt :: Willamette Humane Society

Personal Information

Name: *

Today's Date:

Physical Address:

City:

State:

Zip Code:

Telephone: *

Date of Birth: *

Email Address:

Have you adopted from WHS?:

Sign me up for the WHS newsletter

Do you own?

Type of Residence

Number of people in household

Ages of those under 18

Please tell us about the pets you currently own or have previously owned.

Pet 1

Type of Animal

Gender

Spayed/Neutered?

Age

Indoor/Outdoor?

Still own?

If not, why?

Current on Vaccinations?

Pet 2

Type of Animal

Gender

Spayed/Neutered?

Age

Indoor/Outdoor?

Still own?

If not, why?

Current on Vaccinations?

Pet 3

Type of Animal

Gender

Spayed/Neutered?

Age

Indoor/Outdoor?

Still own?

If not, why?

Current on Vaccinations?

Pet 4

Type of Animal

Gender

Spayed/Neutered?

Age

Indoor/Outdoor?

Still own?

If not, why?

Current on Vaccinations?

Pet 5

Type of Animal

Gender

Spayed/Neutered?

Age

Indoor/Outdoor?

Still own?

If not, why?

Current on Vaccinations?

Questions

Do you currently have a veterinarian?

Who is your Veterinarian?

What made you decide to adopt a dog?

Please check the topics you would like to discuss today:

I have owned a dog before:

My dog will be primarily:

When I am not home my dog will be:

I want a guard dog:

I want a dog to herd or hunt with:

My dog needs to get along with:

What type of confinement do you have for your dog?

How many hours per day will your dog be outside?

Willamette Humane Society Strengthening the bond between pets and people