410-213-0146

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.

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 correct your Have you adopted a pet from us before?.

Please correct your What energy level are you looking for in a dog?.

About Me and My Home

Please correct your What type of home do you live in?.

Please correct your Number of adults in your household:.

Please correct your Number of children (under age 18) in your home.

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

My Habits

Please correct your How much time daily will you spend with your dog?.

Please correct your Does your home have a dog or cat door?.

Please correct your Describe the living environment for your new dog:

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

Please correct your What type of obedience training do you plan to use?.

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

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

Contact Info

Please correct your First Name.

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Please correct your Date of Birth.

Please correct your Home Phone.

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Please correct your Address.

Please correct your City.

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Please correct your Do you own or rent?.

Please correct your How long have you lived at the address?.

Please correct your Are you.

What pets have you owned in the past?



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

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Please correct your Reference Name 2.

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Please correct your Agreed to terms.

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