Sheboygan County Humane Society
PRE-ADOPTION APPLICATION For Pets OTHER THAN cats & dogs

Description of Pet that You’re Interested in

  * = required fields for this form to work

ABOUT YOURSELF    
*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:
How long at current job?:
 years
Work Phone#
 (xxx-xxx-xxxx)
How many years have you lived at the above address?
 
Your Previous address (if less than 5 years)
City
County:
State:
ZIP:
Co-applicant (Spouse or Significant Other):
 Date of Birth? (mm/dd/yyyy)
First Name:
  Last Name:
Employer:
 Occupation:
How long at current job?:
 years    

ABOUT YOUR HOME:
You live in: trailer/mobile home Apartment House
Do you: rent home own home  
Other Family Members:
How many people are currently living at this residence?
Men:
number?
ages?
Women:
number?
ages?
Girls
number?
ages?
Boys:
number?
ages?
Please tell us the names of the people in your household:  
Do you plan on moving in the
next 6 months?
 Yes No Would your pet go with you if you moved?
 Yes No

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?

ABOUT A NEW PET IN YOUR HOME
Have you applied to adopt or adopted from our Shelter or other animal shelter before?
yes no
If from another shelter, which one?
What veterinary hospital do you use (or do you plan to use)?
Are your current pets up-to-date with their vaccinations?

Under whose name are the veterinarian hospital records?
Please list your veterinarian's phone number
(xxx-xxx-xxxx)

Can you provide a permanent home for this petfor 10-15 years?
Yes No
If no, please explain:
Who is going to be the main cat caregiver?
What best describes the main pet caregiver?  (check all that apply)

Do any family members have allergies?
Yes No
Have you ever given a pet up because it didn't work out?
Yes No
If so, please explain the circumstances and what happened to it:
It may take your new pet two weeks or longer to adjust to its new home. Are you prepared to allow for this adjustment period?
Yes No
On an average day, how long will your new pet be left without human companionship?
hours
Are you familiar with the pet laws in your area?
Yes No
What brand of food do you plan to feed?
Do you plan to allow your new pet outdoors?
Yes No
If yes, under what circumstances
If you rent, do you have the landlord's permission to own a pet?
if yes, who is the landlord?
What is the landlord's phone number?
(xxx-xxx-xxxx)
Are the people in your home experienced with pets?
Yes No
Is everyone in the household agreeable to
getting a new pet?
Yes No
Reason for adopting this pet:
Please enter any additional comments that you may have regarding this application:

For applicants outside of Sheboygan County:
References, outside of your family:
  Name Phone Number
1
 (xxx-xxx-xxxx)
2
 (xxx-xxx-xxxx)
3
 (xxx-xxx-xxxx)

Please list your area shelters and their phone numbers
  Shelter Phone Number
1
 (xxx-xxx-xxxx)
2
 (xxx-xxx-xxxx)
3
 (xxx-xxx-xxxx)


The undersigned applicant hereby grants the Sheboygan County Humane Society permission to confirm any information provided in this application with any appropriate third party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by the Sheboygan County Humane Society for purposes of this adoption application.

I certify that all the information on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I also understand that this adoption application is the sole property of the Sheboygan County Humane Society.

It is specifically understood that the Sheboygan County Humane Society reserves the right to deny any adoption application at its own discretion.

Typing your name below will serve as legal signature.
By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue cat and possible removal of said cat from my home. Applicant must be 18 years of age or older. We reserve the right to refuse any applicant.
Date: Driver's license #:

 

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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!