Thank you for your interest in adopting a dog from the West Memphis Animal Shelter. We want to place our pets in permanent, responsible homes and at the same time match you with a pet that is suitable for your family and lifestyle. We reserve the right to decline any application, In the event that we do not feel that your home would be the right fit for a particular pet, we will be happy to try connecting you with a pet that will be a better fit.

Name of dog applying for:

If you do not have a particular dog in mind, please give a description of what kind of dog you are looking to adopt.

Type of dog applying for:

Your Name

First Name

Last Name

Phone Number

Address

City

State

Zip Code

Email Address

*Must have email for Microchip registration.

Have you adopted from WMAS before? If yes, please provide the type of pet and name.

Have you adopted a shelter pet before?

Are you over the age of 21?

Number and age of children living in the home

Do you own your own home? If no, please provide the name and contact number for your landlord.

Is your yard completely fenced in?

Please provide information about your fence (height, material). If you do not have a fence, please explain how you will keep the dog contained on your property.

Where will the animal primarily be kept?

How many hours a day will the dog be left unattended?

Are you going to crate train?

Are you financially prepared for any unexpected expenses such as an emergency clinic or chronic illness?

Give a detailed explanation of why you want the particular breed you are applying for.

Do you have any cats or small animals in the home? Please explain.

Have you ever given up an animal? If yes, when and why?

Who will be the primary caretaker of this dog for feedings, veterinary visits, grooming, and purchasing supplies?

How do you plan to integrate this dog into your family?

Do you currently have any pets? If yes, please give name, breed, age, sex, if they are spayed/neutered, up to date on vaccinations, and on heartworm preventative.

Please list any pets you have had in the last 10 years. Please give name, breed, age, sex, if they were spayed/neutered, and why they are no longer with you.

Please provide the name and contact number for your vet

Under whose name are the animal's medical records listed under?

Are your dogs on monthly preventative for heartworms? List the brand of preventative.

Any additional information you would like to provide.

Dog Application