Adopt a Dog Dog Pre-Adoption Form "*" indicates required fields Name* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* How many people live in your home?* What are the ages of everyone living in your home?* How long have you lived at this address?* Are you planning to move in the next 2 years?* List the name and age of the person that will be primarily responsible for the care of the dog.* What kind of dog are you looking to adopt?If there is a particular dog you are interested in adopting, please enter the name of this dog below.Interested in: Breed Age Puppy Adult Senior Size Small (up to 20 lbs) Medium (20-45 lbs) Large (45-75 lbs) X-Large (75 lbs and up) Sex Male Female Why do you want a dog? As a companion for me / my family For my children As a companion for another pet As a gift Other Please specify other. On average, how long will the dog be left home during the day?* 1-3 Hours 4-7 Hours 8-11 Hours 12-15 Hours I prefer a dog who:* Will enjoy walking on a leash with me. Will run/jog/hike with me. Requires only enough exercise to do his/her business. Will enjoy walking on and off a leash. Will exercise him/herself in my yard. Will enjoy going to dog parks. Where will the dog live?*Make a selectionInside most of the time, outside rarely.Inside when you're home, outside when you're not.Inside half the time, outside half the time.Outside most of the time, inside rarely.What outdoor space, if any, is available for the dog?Make a selectionUn-fenced yardDog houseDog runTied upFenced-in yardType of fence Height of fence The expense of owning a dog can vary greatly depending upon its individual needs and your lifestyle. Costs include regular and emergency veterinary care, medications, food, training, flea control, grooming and boarding. To help us recommend the right dog for you, please indicate how much you can comfortably afford to spend each year:*Make a selectionUnder $200$200 – $500$500 – $1000Whatever it takesIf you were no longer able to care for the dog, what plans would be made?*Current PetsPlease describe the pet(s) currently living in your home. Include their name, species/breed and how long you have owned them.*DetailsWhat is the name and location of the animal hospital that cares for your pets?*DetailsPreviously Owned PetsDescribe the pet(s) you have owned within the past ten years. Include their name, species/breed, how long you owned them and what happened to them.*DetailsWhat is the name and location of the animal hospital that cared for your previous pets?*DetailsEnvironmentAre there children regularly visiting your home? Yes No When it comes to keeping a clean and tidy home, you are:Make a selectionVery particularParticularNot so particularWhen it comes to relating to dogs, do you tend to be more: Strict, a real leader type of dog owner Lenient, a soft, easy going dog owner The noise/activity level in your home is usually:Make a selectionBusy (visits from friends, parties, etc.)Noisy (TV, stereo, machinery, kids playing, etc.)Moderate (normal comings and goings)Quiet (homebodies, few guests)Do you live in a:*Make a selectionHouseApartmentCondo/CoopOtherSpecify Other Do you own or rent?* Own Rent (Copy of Lease or Landlord Letter Required) Additional InformationHow did you find out about the Humane Society of Westchester?Make a selectionFlyer/PosterWord of mouthRadio/TVVeterinarianNewspaperInternet siteOtherVeterinarian name Newspaper name Internet site Other CAPTCHA Δ If you’re looking for a new four-legged friend, you’ve come to the right place! With a variety of dogs and cats available for adoption of all ages, breeds, sizes and colors, you just might find your perfect match!