HSSI Adoption Pre-Approval Application

Contact Information We require complete contact information so that we may reach you in the event you are approved for adoption.
Today's Date *
First Name *
Last Name *
Home Phone * This should be the primary phone we should use to contact you if needed.
Cell Phone
Work Phone
Email *
Street Address * Please enter your current postal mailing address. Include Apartment number or P.O. Box if necessary.
City *
State *
Zip Code *
Your Current Occupation *
I am at least 18 years of age (yes or no) *
Residence
Do you live in a
For your primary residence (where you will be keeping this pet), do you
If you rent, please provide the name and number of your landlord.
If you rent, list any restrictions on pets. If none, please indicate "None."
Household
Your Partner's Name
Please list the names of all other adult members of your household (anyone who lives with you the majority of the time).
Please list all the names and ages of children living in your household.
Pets in the Household
If you already have pets, please list all of them. Include each animal's name, age, sex, and species (such as cat or dog).
If you have pets, are they all spayed or neutered?
If you have pets, what is the name of your current veterinarian?
If you have pets, what is the phone number for your current veterinarian? (We may call for their reference.)
Adoption Preferences
What kind of pet are you looking to adopt?
Would you consider adopting more than one pet at the same time?
What size pet are you looking for?	Small Medium Large No Preference
Age Group Preference	Baby Young Adult Senior No Preference
Must be	Good with Cats Good with Dogs Good with Children Housetrained
Breed Preference
If you are interested in a specific animal you've seen listed, please select it here. If not listed, it may have already been adopted.
If we do not currently have what you are looking for, would you like to be placed on our waitlist?
If all information above is the most up to date that it can be, please sign below and submit your adoption survey! Please allow up to a week for your application to be reviewed and one of our adoption counselors will give you a call to help find your new best friend! To sign with a touch enabled device, sign with your finger. To sign from a device without touch, click and drag the mouse pointer to create your signature. Use the "clear" button to retry a signature.
Signature *

Humane Society of Southern Illinois | 95 Humane Road, Murphysboro, IL 62966 | 618-457-2362

HSSI Adoption Pre-Approval Application

Contact Information

Residence

Household

Pets in the Household

Adoption Preferences