Adoption Application

Animal Information

Animal Name (required)

Type of Animal (required)

Gender (required)
MaleFemale

Adopter Information

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)

Housing

Type of Residence

How long have you resided at this address?

Do you rent or own? (required)
OwnRent

Landlord’s name:

Landlord’s phone number:

Family Information

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

Veterinary Reference

Vet's Name

Clinic Name

Address (required)

City (required)

State (required)

Zip (required)

Phone

How long have you been with this vet?

Alternate Veterinarian Name & Phone

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

Spayed/Neutered?
YesNo

Pet 2

Spayed/Neutered?
YesNo

Pet 3

Spayed/Neutered?
YesNo

Pet 4

Spayed/Neutered?
YesNo

Pet 5

Spayed/Neutered?
YesNo

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.

Pet 1

Spayed/Neutered?
YesNo

Pet 2

Spayed/Neutered?
YesNo

Pet 3

Spayed/Neutered?
YesNo

Pet 4

Spayed/Neutered?
YesNo

Pet 5

Spayed/Neutered?
YesNo

Have you ever sold, rehomed, or surrendered a pet?
YesNo

Adopter Information

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

Certification

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