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 *

Humane Society of Walden Home

HSW Adoption Application

CONTACT INFORMATION

HOUSEHOLD INFORMATION

PET HISTORY

CURRENT PETS (if applicable)

VETERINARIAN INFORMATION

PERSONAL REFERENCES