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.
Do not send me email updates