Sheboygan County Humane Society (SCHS) - online adoption application

Sheboygan County Humane Society
Adoption Application

So that we may be assured that the animal you want to adopt will be best suited for you, your home and lifestyle, we would like you to provide us with the following information.

Date:		Dog	Cat	Animal's Name Tag #
Applicant:
*Name:				*Email:
*Street Address:				*Home Phone:	(xxx-xxx-xxxx)
*City:				*County:
*State:				*ZIP:
Date of Birth	(mm/dd/yyyy)			Cellphone:	(xxx-xxx-xxxx)
Employer:				Occupation:
				Work Phone#	(xxx-xxx-xxxx)
Driver's License

ABOUT YOUR HOME:
You live in:	trailer/mobile home					Apartment		House	Condo/Townhome
Do you:	rent					own
If you rent, landlord/complex name:								Phone:
Please tell us the names (first, last, middle initial and D.O.B.)of the people in your household:
Number of children living with you								Ages?
Do you plan on moving in the next 6 months?	Yes No					If yes, what would you do with your pet
Why would you like to adopt a pet? (check all that apply)
Companion	Watchdog	Mouser	Protection	Breeding	For children	Hunting	gift for whom	Companion for pet if so what type

List animals you currently own or that are in your care/house and those you have owned in the past five years, if you need more room list in comment box below:
Dog Cat Other	Name If other, what:	Breed: Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How long Owned? years	Where is it now?
Dog Cat Other	Name If other, what:	Breed: Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How long Owned? years	Where is it now?
Dog Cat Other	Name If other, what:	Breed: Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How long Owned? years	Where is it now?
Dog Cat Other	Name If other, what:	Breed: Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How long Owned? years	Where is it now?
Dog Cat Other	Name If other, what:	Breed: Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How long Owned? years	Where is it now?
Dog Cat Other	Name If other, what:	Breed: Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How long Owned? years	Where is it now?
Dog Cat Other	Name If other, what:	Breed: Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How long Owned? years	Where is it now?

List present veternarian: Previous veternarians used:
Under what name (including maiden) are/were your pets listed?
Does anyone in your household have pet allergies: yes no	If yes, allergies to Cats or Dogs

Cat Adoptions
Will your cat have free run of your home during the day? yes no	At night? yes no
Will your cat be let outdoors? yes no	If yes, harnessed on a leash? yes no
Do you want your cat to have kittens? yes no
Some cats will "spray" (mark territory with urine) in their homes, are you willing to deal with that? yes no
Cats can live longer than 15 years. Will you be able to care for your pet that long? yes no
Do you plan on declawing your cat? yes no	If yes, front or all 4
Is this a requirement of your lease? yes no
Dog Adoptions
Where will your dog be kept (day)?	(night)?
How will you keep your dog on your property?(check all that apply) Kennel Fenced Yard Invisible Fence On Leash
Do you want your dog to have puppies? yes no	Do you plan on enrolling your dog in training classes? yes no
Are you willing to work with your dog concerning obedience? yes no	Have you ever crate trained? yes no
Dogs often live longer than 12 years. Will you be able to care for your dog that long? yes no
How long will your pet be left alone ( without human companionship) each day?
It may take your pet more than a few days and sometimes weeks to adjust to your home/lifestyle, children, other pets, etc. Are you willing to be patient and take time to work with your new pet? yes no
Have you ever applied for an animal, or adopted from us before? yes no If yes, when
What areas would you like information about? (check all that apply) House training Scratching furniture Alternative to declawing Chewing Stool eating Excessive Barking Obedience Training Digging Introducing cats Preventing Aggression Shy/Fearful behavior Introducing cats and dogs Current Vet list
Are you familiar with local animal ordinances regarding:
Licensing? yes no	Vaccinations? yes no
Leash laws? yes no	Number of pets/household? yes no

APPLICATION COMPLETION DOES NOT MEAN YOU ARE GUARANTEED ADOPTION APPROVAL!

By signing below, I certify that the information I have provided is true and that I recognize that any misrepresentation of the facts may result in my losing the privilege of adopting a pet. I understand that I authorize investigation of all statements in this application, including any veterinary records.

Applicant's Signature: __________________________________ Date: __________________________

Reviewed by:_____________

IF you have problems with this ONLINE form, please:

download application in pdf

download adoption application in .doc format

THEN:

Get the form, type in the data, save the form, and send it to us as an attachment,

-OR

Fax it to us at 920-208-2204

-OR-

Snail Mail it to us at: SCHS
3107 N. 20th St
Sheboygan WI 53083

-OR-

Bring it in to the shelter!