Please fill out all fields marked with an asterisk (*) to complete the form.
Application will not be processed if it's incomplete.
Applicant Information:
First name *
Last name *
Age *
Street address *
City *
State *
Zip code *
Phone number *
Cell Phone
Email address *
Species applying for: *
Cat Dog
Adoptable Animal Interested In:
Ankle (Cat - 722-24)
Arcana (Cat - 232-24)
Athena (Dog - 653-24)
Aubergine (Cat - 773-24)
Axel (Dog - 123-22)
Babe-Z (Cat - 699-24)
Ballot Box (Cat - 702-24)
Banana Creme (Cat - 429-24)
Brody (Dog - 645-24)
Camo (Dog - 456-24)
Chesty (Dog - 711-24)
Courtney (Dog - 145-23)
Cranberry Sauce (Cat - 730-24)
Crew (Cat - 723-24)
Crybaby (Cat - 657-24)
Demon Slayer (Cat - 725-24)
Diva (Dog - 775-24)
Dodo (Cat - 676-24)
Dressing (Cat - 731-24)
Duke AKA Meatball (Dog - 303-19)
Fuchsia (Cat - 768-24)
Gerbil (Cat - 703-24)
Heck (Cat - 685-24)
Itty Bitty Kitty (Cat - 173-24)
Jimmy Buffett (Cat - 643-24)
Lottie (Dog - 712-24)
Luca (Cat - 745-24)
Lucy (Dog - 769-24)
Meadow (Dog - 776-24)
Merry Chrysler (Cat - 772-24)
Merry-Go-Round (Cat - 419-24)
Milli (Cat - 756-24)
Mittenz (Cat - 715-24)
Mother of Pearl (Cat - 747-24)
Nelly (Dog - 749-24)
Ohana (Cat - 735-24)
Potter (Dog - 755-24)
Reba McEntire (Cat - 669-24)
Shopping Cart (Cat - 520-24)
Strawberry Milk (Cat - 442-24)
Stuffing (Cat - 732-24)
Tasmanian (Cat - 675-24)
Tiger Shrimp Whale Face Cat (Cat - 696-24)
Vermillion (Cat - 774-24)
If you are not interested in a specific animal, please describe what type of animal you are looking for: (gender, age, size, etc.)
Please select your current type of housing: *
Please select one type of housing
House Condo/Apartment Mobile Home Student Housing
How long have you lived at your current residence? *
Do you rent or own? *
Please select one
Rent Own
Landlord’s name *
Landlord’s phone number *
Complex name, if applicable
If applicable, else please enter N/A to submit the adoption application.
How many adults live in your home? *
Do children live in the home (or visit regularly?) *
No Yes
Please list the ages of each child *
Are all members of your household aware of your plans to adopt? *
No Yes
Have you ever been convicted of a crime? *
No Yes
If yes, please describe the convicted crime. *
The dog you adopt will spend most of it's time *
Inside Outside Exclusively Outside
The cat you adopt will live: *
Indoor Outdoor Indoor/Outdoor
How would you confine the dog to your property? *
Do you plan to declaw the adopted cat? *
Yes No I want to adopt an already declawed cat
Where will your companion animal sleep? *
Who will be responsible for the animal? *
If necessary, how would you discipline the animal? *
Employment Information:
Please fill out for all of the adults in the household.
Employer *
Job Title *
How long at your present job? *
Additional Employer
Job Title
How long at the additional present job?
Please list your current veterinarian name & phone number, as well as any other vets you have had in the past 5 years.
Primary vet (where your current or previous pets most recent routine care would be):
Vet's Phone Number
Person’s name vet records are under (VERY IMPORTANT).
Additional Vets (please include same information as above)
Current & Past Animals Information:
Please provide information about any previous or current pets that you have owned in the last 5 years. For each pet, please include the following:
Pet's name:
Pet's species:
Pet's breed:
Pet's age:
Where the pet was vetted (if you have more than one vet):
Current Pets:
For previous pets, please also include the following:
If the pet is deceased, and if so when:
If not, why do you no longer have this pet and where they currently are?:
Previous Pets (any from the last 5 years)
Do you have cats? *
No Yes
Do the cats live indoors or outdoors? *
Indoor Outdoor Indoor/outdoor
Are the cats declawed? *
No Yes
Do you have dogs? *
No Yes
Do the dogs spend the majority of their time inside or outside? *
Inside Outside Exclusively Outside
Please provide any additional information about the living conditions of your current pets that may help us find a good fit for your family.
References:
Please list 2 personal references.
Only 1 can be a relative.
Reference Name *
Reference Phone Number *
Amount of time known *
Reference Name *
Reference Phone Number *
Amount of time known *
Adoption Application Questions:
Why do you want to adopt an animal? *
What type of personality are you looking for? *
Who will care for the animal if you are unable?(vacation,illness,emergency) *
I agree to the following:
*
To provide timely health care for the animal.
*
To return the animal to DeKalb Humane Society if you can no longer care for the animal. Must notify us in advance.
*
To keep current license (if applicable) and ID tags on the animal at all times.
*
To allow a DeKalb Humane Society representative to visit your home prior or subsequent to an adoption.
*
I am financially able to care for the animal.
*
That all information contained in this application is true. Should any information be found false, my application will be declined.
*
Should any information be found false after adopting,I will relinquish the animal immediately without refund of my adoption fee, or exchange.
Signature (Please use your finger,stylus or mouse.)
Use finger, stylus or mouse.
Clear
Date *
Please list any additional information you feel is important for us to know.
Optional: Where did you hear about us?