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Dog Adoption Application

Marin Humane Society

The Marin Humane Society
Pets & People Profile (Dog)

Control # _____________
Adoption Date _________
Dog Name ____________
Counselor ____________
IP r ________________

Thank you for filling out this profile.
The information you provide will help us help you find the best match for you and your family.

Name _______________________    Driver's License # ___________________
Street address __________________   P.O. Box_________  City_______________
State ___   Zip ______   Home Phone ______________  Work Phone ____________
May we call you at work to notify you of potential adoptable dogs?     r Yes          rNo
Names of others in household (include ages of children) ______________________
Length of time at address _______ r Own    r Rent   r Live with parents   r Military
Housing type:      r House     r Condo      r Apartment      r Moblie home
Landlord name _____________________ Landlord phone _________________
How did you hear about our adoption program?
r Friend/family r Newspaper ________ r Radio Station________ r TV _______
r Web site (www.marin-humane.org) _____________ r Other _______________
Please list your current veterinarian _____________________ City ___________

Current Pets

You & Your Household

Your Ideal Dog

Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered r Yes r No Kept r Inside r Outside r Both How long have you owned this pet? _____________________	1. Dog Experience r First Time Owner r Have had one or two r Knowledgeable & Experienced	Breed Type/Mix _____________ Adult Size r 0-20 lbs. Small r 20-50 lbs. Medium r 50-100 lbs. Large r Over 100 lbs. Giant Coat r Shortr Medium r Long r No Preference Age r 8-16 weeks r 4-12 months r 1-3 years r Older r No preference Training r None r Housebroken r Some obedience training r Fully trained Activity Level r Low r Mediumr High Sex r Maler Female r No preference
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered r Yes r No Kept r Inside r Outside r Both How long have you owned this pet? _____________________	2. Time Away From Home r Home all day r Out part-time r Away 7-10 hours daily
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered r Yes r No Kept r Inside r Outside r Both How long have you owned this pet? _____________________	3. Our Dog Will Live: r Indoors only r Indoors/Outdoors r Outdoors only
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered r Yes r No Kept r Inside r Outside r Both How long have you owned this pet? _____________________	4. Home Atmosphere r Grand Central Station r Some activity r Zen-garden serene

Past Pet History

Please Describe Your Ideal Dog

Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered r Yes r No Kept r Inside r Outside r Both How long have you owned this pet? _____________________
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered r Yes r No Kept r Inside r Outside r Both How long have you owned this pet? _____________________
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered r Yes r No Kept r Inside r Outside r Both How long have you owned this pet? _____________________

Staff Comments

Date Called

Animal's Name

Guideline Exceptions

Date ______ Counselor Initials ______ Approved ________ Denied/Priors Made ______
Pending Landlord Approval (date) _____ Recieved (date) ______Applicant Informed ___
Pending Parent Approval (date) ______ Recieved (date) ______ Check Impound File ____

Courtesy of

171 Bel Marin Keys Blvd.
Novato, CA 94949
(415) 883-4621
(415) 382-1349 fax