Humane Society Office: 410-749-7603

Wicomico County Animal Control: 410-749-1070

Salisbury City Animal Control: 410-548-3165

Dog Adoption Application

    Please Answer ALL Questions. There may be some that do not apply to you. For example, If you own your house you do not need to provide landlords name and phone number. IF ANY QUESTION DOES NOT APPLY TO YOU PLEASE ANSWER WITH "N/A"! IF ANY QUESTION IS LEFT BLANK UPON SUBMISSION WE WILL BE DELETING YOUR APPLICATION!

    Dog name and shelter ID#:

    Your name:

    Current date and time:

    Home address (Street Name and Street Number):

    Home address (City, State, and Zip Code):

    Home phone:

    Cell phone:


    Your employer:

    Length at current job:

    Personal reference 1(Cannot be related to you)

    Their phone number:

    Relationship with person and years known.

    Personal Reference 2(Cannot be related to you)

    Their Phone Number:

    Relationship with person and years known.

    About Your Home

    Do you live in:

    Do you rent or own:

    If you are renting, is your name on the lease?(If You Own Put N/A)

    If you are renting, do you have your landlords permission?(If you own put N/A)

    Landlords name and phone:(if you own put N/A)

    Name and age of all household residents:

    At what age do you believe children are responsible enough to care for the dog unassisted:

    Is anyone in your house allergic to dogs?:

    How many hours will your dog spend alone each day?:

    Where will Your dog spend the day when you are home?

    Where will your dog be kept when left home alone?:

    When will your dog be outside?:

    When will your dog be inside?:

    Where will your dog sleep?:

    About Your Yard

    What area(s) outside are available to your dog?

    Front YardBack YardEnclosed PatioDog HouseGarageOther(explain in additional comments)

    Do You Have A Doggie Door?:

    Is your yard shared with neighbors?:

    Is your yard fenced?:

    If es, what type of fence and how tall is it:

    Your Experience With Dogs

    Describe your dog owning experience:

    Have you ever had to give an animal away?:

    What were the circumstances?(if you never have, put N/A)

    Do you currently have pets?:

    Current pet breed, type, gender, age, spayed/neutered?:

    What is your veterinarians name and phone number?:

    About This Dog

    What energy level are you looking for?:

    Why do you want a dog?(select all that apply)

    Family PetCompanionGift For Someone ElseProtection/Guard DogChilds CompanionCompanion For Other PetOther(Explain in additional comments field)

    Will you be crate training your dog?:

    How will you exercise your dog and how often?:

    What type of training are you interested in with your dog?:

    Have you or would you be willing to enroll your current dog in obedience class:

    How would you discipline your dog if they misbehaved?:

    What method will you use to housetrain your dog?(Select all that apply)

    Rub Nose In Offending SpotCrate TrainingDo Not Leave Dog UnsupervisedConsult ProfessionalLet Dog Out Every Few HoursOther(explain in additional comments)

    What will you do if your dog develops behavioral problems?:

    In which situation would you let your dog off leash?(Select all that apply)

    Public ParkDog ParkBeachHikeNeighborhood WalkFront yardBackyardOther(explain in additional comments)

    Additional Info

    What would you do if your dog went missing?:

    Can you afford proper medical care, diet, grooming, shelter, and exercise for your dog?:

    Will you take your dog to the vet within 10 days of adoption?:

    Do you understand that your adopted animal may require vet care as a result of shelter related illness?:

    Are you committed to caring for this dog for 15 or more years? :

    If you move what will you do with your dog?:

    Which of the following reasons provided might force you to give up your dog?(select all that apply)

    Excessive Barking/ Neighbor ComplaintsAggressive On LeashDestructive ChewingBiting/AggressionDiggingDivorce/SeparationAllergiesShedding/DirtyNot TrainablePoor WatchdogMovingHouse Training ProblemsFinancial ProblemsGrowling/Nipping at GuestsExcessive Vet Bills/ Chronic illnessHaving a BabyNips Or Bites ChildrenNew Spouse does not like dogsPets Aren't Getting AlongNone Of The AboveOther(Please explain in additional comments)

    Do you have any additional concerns?

    Do you have any additional comments?(this is where you explain why you selected other)

    By signing below, I understand that the falsification or omission of any of the above information will result in automatic refusal of adoption or confiscation of adopted animal. We maintain the right to refuse any application at our discretion. We maintain the right to complete a home check. I authorize HSWC to verify the information in this application. I hereby agree to release, discharge, indemnify and hold harmless the Humane Society of Wicomico County and any of its agents from any and all liabilities that may arise out of the handling by me or my party.

    Sign And Date: