White River
Humane Society

of Lawrence County in Bedford, Indiana

Online Dog Application

Dog Adoption Application

Please fill out the application completely and to the best of your knowledge. Once submitted, the application will be reviewed within 2-3 business days.

1. Have you asked all members of the household if they are in favor of adopting a dog?
2. Is anyone in the family allergic to dogs or pet dander?
3. Have your children been around dogs/puppies before?
4. Many times a new child changes how people react with their dog. If you are considering having children, have you thought about dog hair on the floor where the baby crawls or a toddler getting bit?
5A. Do you own your own home? If you do not own your own home, do you have permission from your landlord to have a dog? What is your landlord's name, phone number, and policy on pets? *
5B. Has there ever been a dog with parvovirus on your property in the last ten years?: *
6. Have you thought about who will care for the dog when you are on vacation, out of town, or sick in the hospital, etc.?: *
7. Pets live 10-20 years, have you considered what you would do with your dog if you moved? Explain: *
8. What would you consider a good reason to give up a pet? *
9. What will your dog primarily be? Family Companion / Companion to Another Animal / Protector of Property / Other *
10. What is your home atmosphere like? Choose One
11. Do you plan to give monthly heartworm preventative? Yes or No, Why or Why Not? *
12. Will the dog be inside or outside?
13. Where will the dog be kept during the day? What about at night? What about when left alone and for how long? *
14A. Will there be a dog house if outside?
14B. Do you have a fenced in yard?: *
15. Will you allow us to do a home visit if need be?
16. Do you understand that this dog/puppy is not guaranteed to be house trained?
17. Are you willing to work with the dog/puppy on any troubled behaviors such as house training issues, biting, or cooperation with other animals?
18. Are you committed to provide vet care for your dog such as check-ups, vaccinations (state law requires all pets over 6 months of age receive rabies vaccinations yearly), heartworm prevention, and flea/tick medicines?
19. How much do you think you will spend yearly for the care of your dog including vet care, heartworm prevention, flea/tick prevention, vaccines, food, toys, and bedding? *
20. Please list all pets you currently have and include their:
Type of pet
If spayed or neutered
Whether indoor, outdoor or both
If declawed
Vet Information (Please provide vet name, vet number, and the person who the pet is under at the vet)
21. Please list pets you have had in the past five years, but do not currently have and include:
Type of pet
Vet information (please provide vet name, vet number, and the person who the pet was under at the vet
What happened to the pet?
How long ago?
Your Name (first and last): *
Your Address: *
City, State, Zip: *
Phone Numbers (Two Please): *
Email Address: *
Would you like to receive our newsletter?:
What dog are you interested in?: *
How did you find out about this animal? Facebook, WRHS website, tv, newspaper, Petfinder, AdoptAPet, Shelter, Other-Please list: *
Please read the following and sign below:
I have answered all of the questions honestly and completely, I am over 18 years of age and can provide proof of ID, and I understand that:
Adopting a pet is a long-term commitment. WRHS reserves the right to refuse/reject my
application at its discretion. Filling out this application does not automatically guarantee approval to adopt the animal nor does it require me to adopt the animal.
I am giving permission to WRHS to contact my landlord and/or veterinarian that I have provided, and my signature allows release of any information necessary to process this application.
Signing this form electronically authorizes an investigation of all information and statements on this form and certifies that all information is truthful and accurate.
Please electronically sign full name and date with month, day, year, and time:
Security Code: *  
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