Adoption Application


Animal Information

Gender (required)
MaleFemale



Adopter Information

Is this your mailing address? (required)
YesNo



Housing

Do you rent or own? (required)
OwnRent



Family Information

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



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.

Spayed/Neutered?
YesNo

Spayed/Neutered?
YesNo

Spayed/Neutered?
YesNo

Spayed/Neutered?
YesNo

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.

Spayed/Neutered?
YesNo

Spayed/Neutered?
YesNo

Spayed/Neutered?
YesNo

Spayed/Neutered?
YesNo

Spayed/Neutered?
YesNo

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



Adopter Information

This pet will primarily be
IndoorsOutdoorsBoth

What will happen to this pet if:

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.