Animal Name (required)
Type of Animal (required) CatDogOther
Gender (required) MaleFemale
Your Name (required)
Address (required)
City (required)
State (required)
Zip (required)
Is this your mailing address? (required) YesNo
Home Phone
Work Phone
Cell Phone
Email (required)
Type of Residence HouseApartmentCondoMobile Home ParkOther
How long have you resided at this address?
Do you rent or own? (required) OwnRent
Landlord’s name:
Landlord’s phone number:
Number of adults in the household (including yourself) (required)
Number of children in the household
children's ages
The primary caregiver of this pet is best described as (check all that apply) RetiredStay at home/Work from homeEmployed part timeEmployed Full timeCollege studentChild/AdolescentOther
Does anyone in the home have known pet allergies? YesNo
Vet's Name
Clinic Name
Phone
How long have you been with this vet?
Alternate Veterinarian Name & Phone
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
Spayed/Neutered? YesNo
Pet 2
Pet 3
Pet 4
Pet 5
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.
Have you ever sold, rehomed, or surrendered a pet? YesNo
This pet will primarily be IndoorsOutdoorsBoth
On average, how many hours a day will this pet be left alone?
Where will this pet be kept when no one is at home?
What will happen to this pet if: ...you travel overnight?
...you move away?
...you lose your job?
...the pet outlives you?
...your family dynamics change?
...the pet develops behavior issues?
...the pet develops health issues?
Do you plan on declawing? YesNo
Are you prepared for a 15-20 year commitment to a cat? YesNo
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.
Do not send me email updates
