Dog Adoption ApplicationDog Adoption ApplicationContact InformationFirst NameLast NameAddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweEmailHousehold InformationDo you Own RentIf renting, any pet restrictions?If renting, landlord contact informationDo you live in- Select -HouseCondo/ApartmentParent's HomeIs there a yard? Is the yard fenced?If yes, how high? What kind?How many people in your household? Ages of children under 18, if any?Do children regularly visit your home?Are you over 18?- Select -YesNoOccupation?Do your pets get regular vet check-ups?Are your pets current on vaccines?If not current on vaccines, why? Do you use flea and tick preventative?My Home EnvironmentActivity level in my household is Low Medium HighActivity level in my neighborhood is Quiet and rural Somewhat active/Suburban Busy/UrbanOn average, my home will be without people ____ hours a day ____ days a week?When home alone, my dog will be...In a crateConfined to a roomYard/GarageLoose in homeMy dog will sleep in _______________I can spend ____ hours a day exercising my dog?If I move, my plan for my pet is:My exercise plan for my dog: My training plan for my dog:It’s most important to me that my dogWhat would cause you to give up a dogWhat is your plan if the dog needed unexpected vet care Do you agree to surrender your dog back to MMHRS in the event you no longer can care for them, or provide them with new owner contact and opportunity to approve new owner?ReferencesCurrent VeterinarianFirst NameLast Name*Please let the vet know to authorize us to call and discuss with your vet and ensure your pets are up to date on neuter/spay and vaccines*1st Non-relative referenceFirst NameLast NameRelationship and How long known2nd Non-relative referenceFirst NameLast NameRelationship and How long known*3rd Reference may be Kitsap Humane Society* I consent to having this website store my submitted information so they can respond to my inquiry I have read and understand the above application and have filled out this form honestly to the best of my ability and certify the above true and am in agreement with the aboveSubmit Form
