Your Name *

First Name

Last Name

Do other adults live in the home with you? *

Yes

No

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Is this phone number a cell or landline?

Cell phone

Landline

Preferred method(s) of contact regarding your application:

Email

Text

Call

Have you previously adopted a pet from the Winona Area Humane Society?

Yes

No

Your Date of Birth (used only for a basic background check) *

MM

DD

YYYY

Do you: *

Rent

Own

Live with the homeowner

Name of Landlord/Homeowner: *

Enter your name if you are the homeowner.

First Name

Last Name

Phone Number of Landlord/Homeowner *

Enter your information if you are the homeowner.

(###)

###

####

Adoption Policies *

Please check each item to acknowledge.

I agree to (do my best to) have all members of the household meet the animal prior to adoption.

I certify & understand that it is a REQUIREMENT that my current animals have an up-to-date rabies vaccination.

How experienced do you feel in caring for a dog? *

No experience, but I'm excited to learn.

Some experience - I've had a dog before.

Lots of experience - friends and family consider me an expert.

How experienced do you feel in securing veterinary care for a dog? *

No experience - but I'm eager to learn.

Some experience - I know how to find a veterinarian for an animal.

I have a vet that I use and love!

Are you aware of any restrictions that would prevent you from adopting a dog? *

No restrictions

Landlord permission

Insurance policies

Weight or size restrictions

Breed restrictions

When I'm not home, my new dog will spend his/her time: *

Check all that apply.

In a crate or kennel inside the home

In a garage or workshop

Loose in the house

Restricted to one room in the house

In the yard

Other (dog day care, with family, etc.)

How would you describe your household? *

Very quiet - only a few residents and not too many guests.

Average - not too quiet, but not party animals.

Very active - lots of people coming in and out.

My dog needs to be good with:

Check all that apply.

Cats

Other dogs

Children under 8 years of age

Children over 8 years of age

Older adults

Other - please explain below

What energy level are you looking for in a dog? *

High energy - needs lots of exercise

Medium energy - daily walks, moderate exercise

Low energy - senior dog or couch potato, yard time is sufficient

Other - please explain below

How will you exercise your dog? *

Check all that apply.

Fenced yard

Loose outside

On leash

Hiking/jogging

Are you familiar with crate training? *

Yes

No

Have you used a crate for a dog before? *

Yes

No

Are you willing to learn about crate training as an option for problem-solving? *

Yes

No

Have you ever dealt with behavioral problems such as digging, barking, jumping, or chewing? *

Yes

No

Have you owned pets in the past five years? *

Yes

No

Are all of your current animals up-to-date on rabies and distemper vaccinations? *

Yes

No

Unsure

I do not currently own any pets

Have you ever given away an animal or surrendered an animal to a shelter? *

Yes

No

Veterinary Clinic Phone Number:

(###)

###

####

If, for any reason, you can no longer keep the animal you adopt and you cannot find a new home for it, do you agree to contact WAHS before taking other measures? *

Agree

Disagree

Do you agree to honor our policy on shock collars? *

Yes

No

Have you read the medical care policy? *

Yes

No

Do you agree to the medical care policy? *

Yes

No

Today's Date *

MM

DD

YYYY