Dog Shelter Adoption Applications Guernsey County Dog Shelter Adoption Form Todays Date:(Required) MM slash DD slash YYYY Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Number(Required)Email(Required) Name of the dog you would like to adopt.(Required)Do you own your home?(Required) Yes No Landlords Name(Required) First Last Landlords Phone Number(Required)Do you have children in the home? Yes No How many children?(Required)Ages of children?(Required)Is the animal being adopted for yourself?(Required) Yes No Have you owned a dog before?(Required) Yes No What breed(s)?(Required)Do you currently have a dog?(Required) Yes No What breed(s)?(Required)Do you have a current dog license?(Required) Yes No Whose name are the tags listed in?(Required) First Last Are your current dogs up to date on Dhlpp/Rabies Vaccines?(Required) Yes No Is anyone in the home allergic to animals?(Required) Yes No Are you willing to work on housebreaking and obedience?(Required) Yes No Do you understand that it will take time for this animal to adjust?(Required) Yes No Do you agree to give this animal time to adjust?(Required) Yes No Do you have a fenced in yard or kennel?(Required) Yes No How do you plan to exercise the dog?(Required)Is this dog going to be kept outside?(Required) Yes No What type of shelter is offered for the dog?(Required)I agree that I will be responsible for proper care of this dog which includes: veterinary care, proper diet, grooming and proper exercise.(Required) Yes No I am aware that from the time of adoption, I am responsible for any medical care the animal needs and that the Guernsey County Dog Shelter will not be responsible for any medical care or expense should the animal become ill.(Required) Yes No Primary reason for wanting to adopt a dog?(Required)Do you have a steady income and home to provide for the new dog?(Required) Yes No Are you 18 years or older?(Required) Yes No Do you currently have a vet?(Required) Yes No Current name the Vet records are under.(Required) First Last Current name of dog(s)(Required)Current Veterinarian’s Name(Required) First Last Current Veterinarian’s Phone Number(Required)Please check with your Vet prior to submitting your application to see if they require authorization before releasing of records. If not able to retrieve records, we will move on to the next application.Consent(Required) I agree to the privacy policy.By submitting this application, I acknowledge that all information on this application is true and correct. I understand that any misrepresentation of fact may result in refusal of adoption privileges to me. Please allow 48 to 72 hours for your application to be processed.CAPTCHA
