HSW Adoption Application

The Humane Society of Walden makes a home for unwanted pets until forever homes are found. We strongly support spay and neuter to reduce the amount of pets in need of homes. Please only apply if your personal pets are currently altered.

Animal you are interested in adopting

I have not decided

Location animal is currently

Walden
Monroe
Middletown

Interested in (check all that apply): *

Cat
Dog
Kitten
Puppy

How Did you Hear about Us *

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 *

Cell Phone *

Email Address *

Employer *

Work Phone *

HOUSEHOLD INFORMATION

Do you live in a *

Do you *

Landlord Name

Landlord Phone

Please explain living situation in detail. *

Do they allow pets?

Do the people you live with Own or Rent?

Landlord Name

Landlord Phone

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?

Why did you surrender the pet?

Have you ever had to give up a pet before?

CURRENT PETS (if applicable)

Dogs/cats in applicants home must be spayed or neutered.

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

Fixed

Gender

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 *

Office Name *

Veterinarian's Phone Number *

PERSONAL REFERENCES

Please Note: References cannot be immediate family members or living in the same home.

We need two references but request a third to expedite application approval.

Name *

Phone *

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. *

Applicant Signature *