Canine (Dog) Adoption Application

We request the following information and a consultation with an adoption counselor to help you find a dog with the qualities you’d like and who matches your lifestyle.

Download Application

To be considered as an adopter, you must:

  • Be 21 years of age
  • Have the knowledge and consent of all adults living in your household
  • Have a valid ID with current address
  • Have the knowledge and consent of your landlord if applicable
  • Understand that The Worcester Country Humane Society must approve your application
Thank you for your submission.

My Preferences

Please select if you have you adopted a pet from us before?

Please select what energy level are you looking for in a dog?

About Me and My Home

Please select what type of home do you live in?

Please select rent or own your home.

Please add the number of adults in your household:.

Please add the number of children (under age 18) in your home.

Please select are there any persons who regularly visit the home (grandchildren, family members, etc)? Explain and list visitor(s) ages below..

My Habits

Please add how much time daily will you spend with your dog?

Please select does your home have a dog or cat door?.

Please describe the living environment for your new dog:

Please add how many hours each day will your dog be home alone without human companionship?.

Please add what type of obedience training do you plan to use?.

Please select when home alone, your dog will be: (check all that apply).

Please select would you allow our representative to visit your home before the adoption is completed?.

Contact Info

Please add your First Name.

Please add your Last Name.

Please add your Date of Birth.

Please add your Home Phone.

Please add your Email.

Please add your Address.

Please add your City.

Please add your State.

Please add your Zip Code.

Please select if you own or rent?

Please select how long have you lived at the address.

Please add your status.

What pets have you owned in the past?

Please list 2 personal references (not related to you)*

Please add your Reference Name 1.

Please add your Reference Phone 1.

Please add your Reference Name 2.

Please add your Reference Phone 2.

Please select your Agreed to terms.


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