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2. Shelter number or name of dog you are interested in:
4. Name:
5. Primary Phone #:
7. Address:
8. Secondary Phone:
10. City/State/Zip
11. Email:
13. Are you at least 18 years old?

    1. Yes
    2. No
14. Do you own or rent the property in which you reside?

    1. Own
    2. Rent
    3. Live With
16. If you rent or live with someone, do we have permission to contact them?

    1. Yes
    2. No
18. Landlord’s/Property Owner’s Name and Phone Number:
20. If you were to move, what are your plans for the care of your pet?
22. How many adults live at your residence?
23. How many children live at your residence?
24. Ages of children:
26. Is the pet a gift?

    1. Yes
    2. No
27. If yes, who is it for?
31. Please list below any current animals in your household:
33. PET #1
35. Pet Name
36. Male/Femal

    1. Male
    2. Female
37. Cat/Dog

    1. Cat
    2. Dog
38. Other - Please Specify
40. Breed
41. Age
42. Spayed/Neutered

    1. Spayed
    2. Neutered
43. Up to date on shots?

    1. Yes
    2. No
45. Who is listed as owner for the pet?
47. PET #2
49. Pet Name
50. Male/Femal

    1. Male
    2. Female
51. Cat/Dog

    1. Cat
    2. Dog
52. Other - Please Specify
54. Breed
55. Age
56. Spayed/Neutered

    1. Spayed
    2. Neutered
57. Up to date on shots?

    1. Yes
    2. No
59. Who is listed as owner for the pet?
61. PET #3
63. Pet Name
64. Male/Femal

    1. Male
    2. Female
65. Cat/Dog

    1. Cat
    2. Dog
66. Other - Please Specify
68. Breed
69. Age
70. Spayed/Neutered

    1. Spayed
    2. Neutered
71. Up to date on shots?

    1. Yes
    2. No
73. Who is listed as owner for the pet?
75. PET #4
77. Pet Name
78. Male/Femal

    1. Male
    2. Female
79. Cat/Dog

    1. Cat
    2. Dog
80. Other - Please Specify
82. Breed
83. Age
84. Spayed/Neutered

    1. Spayed
    2. Neutered
85. Up to date on shots?

    1. Yes
    2. No
87. Who is listed as owner for the pet?
89. PET #5
91. Pet Name
92. Male/Femal

    1. Male
    2. Female
93. Cat/Dog

    1. Cat
    2. Dog
94. Other - Please Specify
96. Breed
97. Age
98. Spayed/Neutered

    1. Spayed
    2. Neutered
99. Up to date on shots?

    1. Yes
    2. No
101. Who is listed as owner for the pet?
103. Please use the space below for any additional information regarding current animals in your household:
107. Name and phone number of veterinarian you currently or plan to use:
111. Have you ever surrendered a pet to a shelter before?

     1. Yes
     2. No
112. Have you ever given away or sold a pet before?

     1. Yes
     2. No
114. If yes to either above, please explain:
116. Have you ever lost a pet due to being strayed, stolen, hit by car, disease, or old age?

     1. Yes
     2. No
117. If yes, please explain?
121. Do you have a fenced in yard?

     1. Yes
     2. No
122. If no, how do you plan to exercise the dog?
124. Will this dog be an indoor or outdoor pet?

     1. Indoor
     2. Outdoor
     3. Both
125. If you answered outdoors or both, what type of housing/kenneling do you plan to use?
129. Would you be willing to adopt a special needs dog?

     1. Yes
     2. No
130. If yes, please list specifics:
134. Please check any of the reasons that may cause you to return a dog to our animal shelter:

     1. Showing unexpected aggression toward people or other animals
     2. The dog does not get along with my current pets
     3. The dog is destructive in the home.
     4. Difficulty with house training.
     5. Barking, whining, or vocalizing excessively.
     6. The dog requires more time, training, or exercise than expected.
     7. Unexpected veterinary expenses.
     8. Other (please explain below)
136. Other (explanation)
140. Have you adopted an animal from us before?

     1. Yes
     2. No
141. If yes, when?
143. Do you still have the animal that you adopted from us?

     1. Yes
     2. No
144. If no, why?
146. Do you understand it takes a new dog time to adjust to their new environment?

     1. Yes
     2. No
147. Do you understand the responsibilities of owning a dog?

     1. Yes
     2. No
149. Sometimes, successful integration of a new dog into a household with existing pets requires patience and structured introductions. This may include keeping pets separated initially, slow introductions, and supervised interactions. This may take several weeks. Are you willing to follow this process if needed?*

     1. Yes. I have past experience with this.
     2. Yes. I am willing to learn.
     3. Unsure. Please explain how this process might look for me and/or my family.
     4. No.

     (Answering "No" does not automatically disqualify you from adopting. This question simply helps us understand your comfort level with this process.)

151. Please add additional comments if needed, regarding your comfort level with new pet introductions.
153. Comments you would like to provide regarding your application:
157. By submitting this application for adoption, I certify that the information I have given is true and everyone in my household is supportive of this adoption. I understand without exception, failure to give honest answers or failure to answer all questions could result in denial of this adoption. I authorize that the questions above may be used in reviewing my application. I understand that for any reason, as the adopter, it is my responsibility to follow the city/county/state ordinances in which I live in, regarding animal welfare and the care of my animal(s). If the dog that I am adopting, is involved in an altercation or bite incident, it is not the responsibility of this shelter. I understand and agree that if for any reason, I am unable to care for my adopted pet or my living arrangements were to change where I am unable to keep it where I reside, I will contact Story County Animal Shelter to discuss the return of my animal.

     Please initial below statement, confirming you have read through completely. 

159. PLEASE ALLOW AT LEAST 2-3 BUSINESS DAYS FOR YOUR APPLICATION TO BE REVIEWED. THERE MAY BE SEVERAL APPLICATIONS FOR EACH ANIMAL. WE DO NOT ADOPT OUT ANIMALS ON A FIRST COME, FIRST SERVE BASIS. SUBMITTING AN APPLICATION IS THE FIRST STEP OF THE ADOPTION PROCESS, AND DOES NOT GUARANTEE APPROVAL FOR AN ANIMAL.

     We reach out by email (preferred method) and/or phone. If you have not heard back from us regarding your application please check your junk or other folder as it may have been diverted there. 

163. *PLEASE SIGN BELOW, I HAVE ANSWERED EVERYTHING COMPLETELY AND TRUTHFULLY AND I HAVE READ AND UNDERSTAND ALL OF THE ABOVE INFORMATION*
165. Your Signature
166. Date
     Date
168. Story County Animal Shelter/Animal Control, is dedicated to finding caring and responsible homes for their animals. All applicable ordinances and laws for Story County are observed and enforced by this department. Story County Animal Shelter appreciates your understanding and support!
170. THIS APPLICATION WILL REMAIN ON FILE FOR 90 DAYS.- AFTER THAT A NEW ONE MUST BE COMPLETED IF YOU ARE CONSIDERING ADOPTION AGAIN.
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172. 1. Receive an email copy of this form.
173. Email address

     This field is not part of the form submission.

174. Submit Submit and Print

* indicates a required field