Adoption Application

Animal Information

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

Adopter Information

What is your name?
Where do you live?
In what city?
In what state?
The zip code is required.
Is this your mailing address?
Please enter your mailing address
City is required
State is required
The zip code is required
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Please provide your email address so we can contact you

Housing

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Please describe the type of dwelling
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Do you rent or own?
What is the landlord's name and phone number?
Are pets allowed at this address?
Please provide an explanation
Please describe the yard

Family Information

How many adults, including you?
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Please describe the primary caregiver
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Please describe the nature of the allergy

Veterinary Reference

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Please enter the phone number with the area code
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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.
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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 was spayed or neutered, and how long you owned it.
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Please explain the circumstances for giving up your pet

Continued Care Information
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What will happen to this pet if:
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Certificatin

Please type what you see in the picture
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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.