Watonwan County Humane Society Adoption Application Pet's Name:	Date:

Please fill out this application as completely and accurately as possible. By doing so, it will allow us to fulfill our responsibility of finding the best homes possible for the animals in our care and allow us to better assist you in finding a pet best suited for you. Thank you.

Applicant's Name (Adopter): Email:

Home #: Cell #: Work #:

Address: City: State: Zip:

Vet Clinic (Name/City/State): Phone #:

Are you 18 years old or older? Yes No Your age?

a. How many adults live in your household?

b. Do all adults have knowledge and agree with your intentions to adopt a pet? Yes No

c. How many children live in your household? Ages

d. Does anyone in the house have allergies to pets? Yes No

If yes, how do you plan to manage this issue?

What is your housing situation?	Own	Rent

Where do you live? House	Apartment	Mobile Home Condo/Town Home

If you rent:

Do you have permission to have a pet? Yes No

Landlord's name and phone number:

Is your home in town or in the country? Town Country

Are you planning to move in the next six months? Yes No

If yes, what will you do with your pet?

Is the pet specifically for your household? Yes No

Who will be the pet's primary caregiver?

What is your reason for adopting at this time?

Check all that apply:	Companion for me and my family	Hunter

Companion for my other pets	Watch dog

Have you ever adopted a pet from Watonwan County Humane Society? Yes No

If yes, what?	Where is the pet now?

Have you ever surrendered an animal to a humane society? Yes No

If yes, why?

Have you ever had to euthanize a pet? Yes No

If yes, what were the circumstances?

PLEASE LIST TWO PERSONAL REFERENCES

List 2 people who can attest to the fact that you would be a good pet owner [not family members]:

Name: Phone #: Phone #:

Name: Phone #: Phone #:

(over)

CURRENT AND PREVIOUS PETS –List current pets first then previous pets. (Cont. on separate sheet if needed)

Under what name(s) will the vet information be listed?

PET'S NAME TYPE	BREED	GENDER	AGE/DOB	SPAY/NEUT.	DATE OF LAST STILL HAVE

VET VIST	PET?

1)	Dog Cat	M F	Yes No	Yes No

2)	Dog Cat	M F	Yes No	Yes No

3)	Dog Cat	M F	Yes No	Yes No

4)	Dog Cat	M F	Yes No	Yes No

5)	Dog Cat	M F	Yes No	Yes No

12.	If you currently have pets, where are they kept? Indoors Outdoors Both

13.	Where do you plan to keep this pet? Indoors Outdoors Both

a. Where will this pet be kept days?

b. Where will this pet be kept nights?

c. If adopting a dog, how will this dog be contained when outside?

Fenced in yard Kennel Invisible Fence	Tie Out On a Leash

Other - Explain:

14.	If adopting a dog that will be an outside dog, will this dog have protection from the weather and sun, such as a dog house or building? Yes No If yes, what will it be?

15.	If you have or have had cats, have you declawed them? Yes No If yes: Front All 4 paws

16.	If adopting a cat, do you plan to have it declawed? Yes No If yes: Front All 4 paws

17.	How many hours per day will this pet be alone? 0-4 hrs. 4-8 hrs. 8-12 hrs. 12+ hrs.

18.	I understand that if I adopt this pet, I am agreeing to care for it for its entire life? Yes No

Applicant (Adopter) - Employment Information:

Employer: Position: Phone #:

Address: City: State:

How long with this employer? Are you a college student?

Co-Applicant’s (Adopter) Full Name:	- Employment Information:

Employer: Position: Phone #:

Address: City: State:

How long with this employer? Are you a college student?

By signing below, I certify that the information I have given is accurate and complete and I understand

that any misrepresentation of the above information may authorize the Watonwan County Humane Society to deny my application, refuse the adoption, and/or reclaim the adopted pet. I give the Watonwan County Humane Society permission to check my housing and employment information and contact my veterinarian to check the information provided on my application, etc.

Signature: ________________________Date: __________ Humane Society Staff: _________________Rev 4/4/14