Adoption Application

I/We are looking to adopt a: *
Animal name (if known):
Primary Adopter's First Name *
Primary Adopter's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly as this is the main way we will contact you
Date of Birth *
Drivers License/State Issued Identification Number *
Alternate Phone Number
Secondary Adopter's First Name If applicable: Name of other adult living in your home.
Secondary Adopter's Last Name
Secondary Adopter's Phone Number
Secondary Adopter's Email Address
Name of other adults Living in the home? *
Have anyone in your home ever been convicted of abuse or neglect of a child, vulnerable adult or animal? *
Including yourself, how many people live in your household? *
Please list the ages & relationship of those who live in your home. *
Is everyone in your household aware that you are planning to adopt a pet? *
Does anyone in your household have allergies to dogs/cats? *
Is this pet for you or someone else? *
Employment Status *
If you chose "other" above, please explain:
Where do you work?
I/We Live in a : *
If you answered "other" above, please explain here:
Do you own or rent your home? *
How long have you lived at this address? *
If you rent, does your landlord and lease allow pets?
If you rent, please include contact information for you landlord.
Do you have a completely fenced-in yard? If so, what kind of fence? *
How many pets have you owned in the last 5-10 years? *
What happened to them? *
Do you currently have any other pets? *
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed? *
Are your pets current on their vaccinations? *
Do you have a regular veterinarian? *
Veterinarian's Name * If you have never owned a pet please tell us where you would go.
Veterinarian's Address, City, State, and Zip Code * Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number *
Please check the main reason you plan to adopt a pet: *
Please describe in detail the pet you are looking for. *
Have you ever brought an animal into a shelter? *
If yes, please explain?
What questions or concerns do you have about adopting a new pet? *
How much do you anticipate to spend on your new pet each year? *
Will this pet be predominantly living inside, outside, or both? *
Where will your new pet be kept during the day? *
Where will your new pet be kept at night? *
If you answered "other" above, please explain:
On average, how many hours per day will your pet be left alone? *
Where will your new pet be kept while home alone? *
How will your new pet be contained while outdoors? *
For what reason(s) would you consider returning/giving up your new pet? *
If adopting a cat, do you plan to declaw? *
How will you handle housetraining? *
How will you handle destructive behavior? *
What questions do you have about training your new pet?
Pets may take a month or longer to adjust to their new home, are you prepared for this adjustment period? *
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I hereby grant the Humane Society of Barron County permission to confirm any information provided in this application for the purposes of determining adoption eligibility. I understand that my application may be denied if I provided any false information. I understand completion of this form does not guarantee approval to adopt. I understand the Humane Society of Barron County reserves the right to deny any applicant for any reason. *
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Please note: When we receive a high volume of applications the HSBC is not always able to respond to every application. Please be patient as we work to find loving homes for the animals in our care.
By signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application. Click on the line, hold down the mouse, and draw your signature.
Date: *