Monroe Adoption Application

Animal you are interested in adopting
This new pet will live *
CONTACT INFORMATION
Applicant's First Name *
Applicant's Last Name *
Applicant's Age *
Street Address *
Mailing Address (If Different)
City *
State *
Zip Code *
Phone Number * Please use the following format 248-555-1212
Cell Phone *
Email Address * Please enter correctly as this is the main way we will contact you
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Employer *
Work Phone *
HOUSEHOLD INFORMATION
Do you *
Landlord Name
Landlord Phone
Do they allow pets?
Do you live in a *
Do you anticipate moving within the next 6 months? *
If you move in the future, what will you do with your pet(s)? *
How many people reside in your household? *
Ages of children under 18, if any *
Are they used to animals? *
Do all household members know you are adopting a new pet? *
PET HISTORY
Have you adopted from us before?
Do you still have the pet? *
What happened to this pet?
Have you ever had to give up a pet before?
Why did you surrender the pet?
CURRENT PETS (if applicable)
Name
Species
Gender
Fixed
Age
Time Owned
Current on Shots

Name
Species
Gender
Fixed
Age
Time Owned
Current on Shots?

Name
Species
Gender
Fixed
Age
Time Owned
Current on Shots

Name
Species
Gender
Fixed
Age
Time Owned
Current on Shots

Name
Species
Gender
Fixed
Age
Time Owned
Current on Shots

VETERINARIAN INFORMATION Please let your veterinarian know that we will be calling for a reference! Most vet offices require your consent prior to speaking with us and we cannot process your application until we do.
Veterinarian's Name * If you have never owned a pet please tell us where you would go.
Office Name *
Veterinarian's Phone Number *
PERSONAL REFERENCES Please Note: References cannot be immediate family members or living in the same home.
Name *
Phone *
Name *
Phone *

Notes/Comments

I certify that the information that I have given is true, and that any misrepresentation of facts may result in my losing the privilege of adopting an animal from the Humane Society of Walden. This animal will reside in my home as a pet and will be provided with adequate food, water, shelter, training, affection, medical care and humane treatment at all times. *

Humane Society of Walden Home

Monroe Adoption Application

CONTACT INFORMATION

HOUSEHOLD INFORMATION

PET HISTORY

CURRENT PETS (if applicable)

VETERINARIAN INFORMATION

PERSONAL REFERENCES