Dog Adoption Form

Before filling out the application please be aware of the following: All information must filled out in order to consider your application.

Your Personal Information
Applicant's Name:
Co-Applicant's Name:
Address:
City: ZIP Code:
Day Phone: Eve. Phone:
Place of Employment:
Work Phone:
Co-Applicant's Place of Employment:

Co-Applicant's Work Phone:

Email:
May we contact by Email?: Yes   No  
Do you have any children?: Yes   No      
If yes, how many?    

If yes, what are their ages?
(list ages seperated by comma)
Housing Information
Do you live in a:    
Own or Rent Own  Rent    
If you rent, please provide your landlord's contact information below
Name:
Contact Phone Number:
Do you have a yard?
Yes   No  
If yes, is it fenced?
Yes   No  
If yes, what type of fence is it?
If yes, how high is it?
Dog Information
Briefly explain why you're interested in adopting a dog from THSD:
What size of dog do you prefer?
What level of obedience training do you prefer?
Would you consider taking a dog with a lesser obedience level? Yes No
Are you planning on taking your dog to obedience training? Yes No
If yes, which kind?
Where will your dog be kept when alone?
Where will your dog be kept during the day?
Where will your dog be kept at night?
How many hours will your dog be left alone?
Will this be an indoor or outdoor dog? Indoor Outdoor
How will you handle chewing and other destructive behavior?
Do you have a vet? Yes No
If yes, how long have you been going to this clinic?
Clinic name and contact information:
Existing Animals
Do you currently have other animals?
Yes No
  
How many?
 
Are they all current on their vaccinations?
Yes No
  
Are they taking heartwork medications?
Yes No
  
Who cares for your future/current pets?
 
Please list below any animals that you have had in the past 5 years:
 
Type Sex Age Spayed/Neutered Where is it now?
What would cause you to give up your dog?

What would be the "perfect" dog for your family? (Please include energy level, size, hair length, personality)  
Please provide two references who are dog owners and not related to you who might be able to give us additional insight to your life and abilities as a dog owner.
Name:
 
Phone Number:
 
Name:
 
Phone Number:
 
Terms of Adoption - Please read before submitting form.
Terms of Adoption

Cost
The donation required to adopt a Texas Hearing and Service dog may vary, depending on the amount of time the dog has spent in our program and the level of training the dog has received. The donation amount is larger for dogs who have received a substantial amount of training. The donation supports training of Hearing and Service Dogs.The adoption cost does include one in home private training lesson to help the family understand the dog’s ability and training level.

Return Policy
If, for any reason, you are unable to care for this dog any longer, or if Texas Hearing and Service feels that the adoption is not in the best interest of the dog, the dog must be returned to THSD within two weeks of notification at your expense. The dog may not be sold, or given to a new owner. THSD reserves the right to reclaim the dog if this dog is ever abused, neglected or improperly cared for in any way.

Microchip
Some of the dogs are already have been microchiped upon adoption. THSD requires that it remain the primary contact, but will add the adopter to the list of contact. THSD requires that all other dogs be microchiped with in two months of adoption at the adopter’s expense.

License
The adopted dog must be licensed in accordance with existing laws in the adopter’s own town or county.

Vaccinations
The dog must remain current on vaccinations, including Rabies, in accordance to the dog’s veterinarian. The dog must remain on heartworm medicine and receive heartworm tests according to the dog’s veterinarian as well.

Please be aware before submitting this application that there will be follow up interviews if the application is approved which may include a home visit where every family member will need to be present, this will help us place the appropriate dog with your family. Also, by submitting this form you understand that THSD may refuse your application without explanation and that THSD may check with your current veterinarian about your current animals’ care.