February 2013 | Etobicoke Humane Society

Name of Dog you are interested in? *

Have You visited the dog you are applying for? *

Your Full Name *

First

Last

Your email address *

Confirm Email

Primary Phone Number *

Secondary Phone Number

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What type of home will you provide? *

Apartment
Condominium
Detached or semi-detached
Townhouse
Townhouse (condominium)
Other

Date (classes Secondary

Please Specify *

Do you have a yard? *

Yes, with a fence
Yes, with no fence
No

Do you have direct access to the backyard from the house?

Do you have a condominium/rental agreement ? *

Does your agreement allow dogs? *

Is there a size, weight, breed restriction? *

How many adults live in your home? *

What is the occupation of the primary caregiver? *

Full Time
Part Time
Self Employeed
Homemaker
Student
Retired
Unemployed

Are there any children living in your home? *

How many children live in your home?

Selected Value: 1

What are the ages of the children living in your home or who visit often?

5 years and/or under
6 - 9 years
10 - 12 years
13 - 18 years

Choose all which may apply

Does anyone smoke inside your home? *

Does anyone living in your home have allergies to dogs? *

Have you owned a pet in the past? *

What happened to them? *

Deceased
Rehomed
Taken by the City
Surrendered to Rescue/Humane Society
Other

Please Specify *

Do you currently have any Cats and/or Dogs living in your home? *

How many Cats and/or Dogs do you currently have?

Selected Value: 1

Pet #1

Cat
Dog
Male
Female
Spayed/Neutered
Currently on Vaccines
Microchipped
City License

Choose All That Apply

Pet #2

Cat
Dog
Male
Female
Spayed/Neutered
Currently on Vaccines
Microchipped
City License

Choose All That Apply

Pet #3

Cat
Dog
Male
Female
Spayed/Neutered
Currently on Vaccines
Microchipped
City License

Choose All That Apply

Pet #4

Cat
Dog
Male
Female
Spayed/Neutered
Currently on Vaccines
Microchipped
City License

Choose All That Apply

Pet #5

Cat
Dog
Male
Female
Spayed/Neutered
Currently on Vaccines
Microchipped
City License

Choose All That Apply

Pet #6

Cat
Dog
Male
Female
Spayed/Neutered
Currently on Vaccines
Microchipped
City License

Choose All That Apply

Pet #7

Cat
Dog
Male
Female
Spayed/Neutered
Currently on Vaccines
Microchipped
City License

Choose All That Apply

Pet #8

Cat
Dog
Male
Female
Spayed/Neutered
Currently on Vaccines
Microchipped
City License

Choose All That Apply

How many hours a day will your dog/puppy be left alone? *

0 - 2
2 - 4
4 - 6
6 - 8
8 - 10
10+

Will the dog primarily live inside or outside? *

Inside
Outside

Who will look after your dog when you go on vacation, have to travel for work, or a family emergency takes you out of town?

Family
Friend
Board

Choose All That Apply

Will you be committed to walking, socializing and training (classes or personal one-on-one training with a professional dog trainer) your adopted dog? *

How much do you think it will cost for your new dog or puppy in the first year? *

$1 - $500
$501 - $999
$1,000 - $1,499
$1,500 - $1,999
$2,000+

What dog experience do you have? *

Very Little to No Experience - have never owned a dog
Some Experience - have owned a dog
Experienced - have owned dogs and is knowledgeable about dog behaviours and how to manage them
Highly Experienced - have owned dogs, including those with behaviour or medical issues and has successfully integrated these dogs into family life

How Did You Hear About Us? *

Please Specify *

Comments or Questions

Correct Information *

I Agree

I hereby declare that, to the best of my knowledge, the information provided by me above is true and accurate.

EHS Waiver *

I Agree

I understand that in handling animals there is a risk of physical harm caused by the animals. I understand that I may be scratched or bitten by the animals. By submitting this application, I hereby release, discharge, indemnify and hold harmless the Etobicoke Humane Society, its agents, officials and volunteers from all claims, causes of action or demands of any nature or cause, including costs and legal expenses incurred by EHS in connection with the same, based on damages or injuries which may be incurred or sustained by me in any way connected with this adoption process, including but not limited to animal bites, accidents or injuries.

Thank You to Pet Valu 125 The Queensway

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