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Adoption Application

Animal Information

Animal Name (*)
What is the animal's name?
Type of Animal (*)
Are you adopting a dog, cat, or...?
Please describe (*)
Please describe the type of animal since it's neither a dog or cat
Gender (*)
Please specify whether the pet is male or female

Adopter Information

Name (*)
What is your name?
Address (*)
Where do you live?
City (*)
In what city?
State (*)
Please specify the state
Zip (*)
Zip code is required
Is this your mailing address? (*)
Is this your mailing address?
Mailing Address (*)
Please enter your mailing address
City (*)
City is required
State (*)
State is required
Zip (*)
Zip code is required
Home Phone
Invalid Input
Work Phone
Invalid Input
Cell Phone
Invalid Input
eMail (*)
An email address is required when submitting the adoption application online.

Housing

Type of residence
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Please describe (*)
Please describe the type of dwelling
How long have you resided at this address?
Invalid Input
Do you rent or own? (*)
Do you rent or own?
Landlord's name and phone number (*)
Please provide the landlord's name and phone number
Are pets allowed at this address? (*)
Are pets allowed?
Please explain (*)
Please clarify
The yard is (select all that apply) (*)






Please describe the yard

Family Information

Number of adults in the household
(including yourself) (*)
How many adults, including you?
Number of children in the household
Invalid Input
Children's ages
Invalid Input
The primary caregiver of this pet is
best described as (check all that apply)







Invalid Input
Please describe (*)
Invalid Input
Does anyone in the home have known pet allergies?
Invalid Input
Please explain (*)
Invalid Input

Veterinary Reference

Vet's Name
Invalid Input
Clinic Name
Invalid Input
Address
Invalid Input
City
Invalid Input
State
Invalid Input
Zip
Invalid Input
Phone
Invalid Input
How long have you been with this vet?
Invalid Input
Alternate Veterinarian Name & Phone
Invalid Input

Pet Ownership History

Please describe the pets currently residing in your household, including those cared for by relatives and/or roommates. Please include name, the type of pet, breed, age, whether it is spayed or neutered, and how long you have owned it.
Pet 1
Invalid Input
Spayed/Neutered?
Invalid Input
Pet 2
Invalid Input
Spayed/Neutered?
Invalid Input
Pet 3
Invalid Input
Spayed/Neutered?
Invalid Input
Pet 4
Invalid Input
Spayed/Neutered?
Invalid Input
Pet 5
Invalid Input
Spayed/Neutered?
Invalid Input
Please describe the pets you have owned or cared for in the last ten years. Please include name, the type of pet, breed, age, whether it is spayed or neutered, and how long you have owned it.
Pet 1
Invalid Input
Spayed/Neutered?
Invalid Input
Pet 2
Invalid Input
Spayed/Neutered?
Invalid Input
Pet 3
Invalid Input
Spayed/Neutered?
Invalid Input
Pet 4
Invalid Input
Spayed/Neutered?
Invalid Input
Pet 5
Invalid Input
Spayed/Neutered?
Invalid Input
Have you ever sold, rehomed, or surrendered a pet?
Invalid Input
Please explain (*)
Invalid Input

Continued Care Information

This pet will primarily be
Invalid Input
On average, how many hours a day will this pet be left alone?
Invalid Input
Where will this pet be kept when no one is at home?
Invalid Input
What will happen to this pet if:
...you travel overnight?
Invalid Input
...you move away?
Invalid Input
...you lose your job?
Invalid Input
...the pet outlives you?
Invalid Input
...your family dynamics change?
Invalid Input
For example: divorce, death, birth
...the pet develops behavior issues?
Invalid Input
Examples include chewing, scratching, biting, vocalizing, house soiling
...the pet develops health issues?
Invalid Input
Do you plan on declawing?
Invalid Input
Are you prepared for a 15-20 year commitment to a cat?
Invalid Input
Do you plan on going to obedience classes?
Invalid Input
Are you prepared for a 10-15 year commitment to a dog?
Invalid Input

Certification

Please type what you see in the picture Please type what you see in the picture
Please type what you see
By clicking on the Submit button, I certify the information provided on this application is true to the best of my knowledge. I understand that submitting this application does not guarantee I will be able to adopt an animal from the Humane Society of Midland County.