Adoption Form

First Name *
Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly as this is the main way we will contact you
Alternate Phone Number
Date of Birth *
List the names and birthdates of all residents 18+ in the home. *
Do you own or rent your home? *	Own Rent Someone else owns the Home Someone else rents the Home
If you rent, please provide landlord name, phone number, and email
Species you are interested in. *	Dog Cat
I acknowledge that once approved, my adoption form is good for one year and is valid for all HSNEI animals. *	NoYes
I acknowledge that form approval does not guarantee me a specific animal. HSNEI will work with me to identify my ideal pet that best matches my family, home, and lifestyle. *	NoYes
I acknowledge that out of state adoptions require a certificate of veterinary inspection. The cost is $25 non-refundable. *	NoYes