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FOREST COUNTY HUMANE SOCIETY
701 Industrial Parkway
PO Box 57
Crandon, WI 54520
Phone: (715) 478-2098
Fax: (715) 478-2099
License# 268240-DS
Full Name___________________________________________________________________
Address: ___________________________________ City______________________________ State_________ Zip_______
Phone #__________________________ Employer__________________Work phone______________
Spouse/___________________________________ Employer__________________________Work Phone_______________
Roommate
Veterinarian__________________________________________ Vet. Phone_____________________
Email Address:_______________________________________________________
Please provide two non related references:
Name: ______________________________________________ Phone__________________________
Name: ______________________________________________ Phone__________________________
Thank You for your interest in adopting a pet from us. The following application will help us assist you in the selection of a new pet. Please fill in all that applies to you.
I am interested in adopting _______________________________
Do you own or rent your home? Own____ Rent____
If rent, Landlord Name: __________________________________________ Phone number_______________________
How many members in your household? Adults____ Children (over ten)____ (under ten) ____
Have you ever surrendered an animal to a shelter before? No____ If Yes, please explain__________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
How many hours a day will the animal be left alone? _____
Where will the animal be kept when home alone?______________________________________________________
Do you own any other pets at this time? Yes____ No____ if Yes please list below:
1. Pet's Name & Breed_________________________________________________ Altered? Yes____ No____ Age____
2. Pet's Name & Breed_________________________________________________ Altered? Yes____ No____ Age____
3. Pet's Name & Breed_________________________________________________ Altered? Yes____ No____ Age____
4. Pet's Name & Breed_________________________________________________ Altered? Yes____ No____ Age____
Are your pets current on their rabies and distemper vaccinations? Yes____ No____
Please READ each of the following and sign below to acknowledge
you agree with these statements
1. I am at least 18 years old.
2. I have consent to adopt an animal from all adults in my home.
3. I have verifiable identification showing my present address.
4. I have a written letter of approval from my landlord to have an animal in my home.
5. I agree to not let the animal run at large or become a public nuisance.
6. I understand that even though The Forest County Humane Society does their best at determining the breed of an animal, we cannot guarantee the accuracy of that determination.
7. I understand that the Forest County Humane Societyhas the right to accept or deny my request.
8. I realize that although the Forest County Humane Society will give your profile full consideration, the animal will go to the family that can provide the best home.
By signing below, I certify that the information I have given is true. I realize that any misrepresentation of facts may result in my losing the privilege to adopt a pet. I understand that the FCHS has the right to deny my request to adopt an animal for any situation that would be contrary to the shelters policies, in violation of state or local ordinances, or not in the best interest of the animal. I authorize the investigation of all statements in this application. I also authorize my veterinarian to release any information requested by the FCHS.
Signature: _________________________________________
Date:________________________
Approved by________________________________________ Case number: __________________
FOREST COUNTY HUMANE SOCIETY
701 Industrial Parkway
PO Box 57
Crandon, WI 54520
Phone: (715) 478-2098
Fax: (715) 478-2099
License# 268240-DS
Full Name___________________________________________________________________
Address: ___________________________________ City______________________________ State_________ Zip_______
Phone #__________________________ Employer__________________Work phone______________
Spouse/___________________________________ Employer__________________________Work Phone_______________
Roommate
Veterinarian__________________________________________ Vet. Phone_____________________
Email Address:_______________________________________________________
Please provide two non related references:
Name: ______________________________________________ Phone__________________________
Name: ______________________________________________ Phone__________________________
Thank You for your interest in adopting a pet from us. The following application will help us assist you in the selection of a new pet. Please fill in all that applies to you.
I am interested in adopting _______________________________
Do you own or rent your home? Own____ Rent____
If rent, Landlord Name: __________________________________________ Phone number_______________________
How many members in your household? Adults____ Children (over ten)____ (under ten) ____
Have you ever surrendered an animal to a shelter before? No____ If Yes, please explain__________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
How many hours a day will the animal be left alone? _____
Where will the animal be kept when home alone?______________________________________________________
Do you own any other pets at this time? Yes____ No____ if Yes please list below:
1. Pet's Name & Breed_________________________________________________ Altered? Yes____ No____ Age____
2. Pet's Name & Breed_________________________________________________ Altered? Yes____ No____ Age____
3. Pet's Name & Breed_________________________________________________ Altered? Yes____ No____ Age____
4. Pet's Name & Breed_________________________________________________ Altered? Yes____ No____ Age____
Are your pets current on their rabies and distemper vaccinations? Yes____ No____
Please READ each of the following and sign below to acknowledge
you agree with these statements
1. I am at least 18 years old.
2. I have consent to adopt an animal from all adults in my home.
3. I have verifiable identification showing my present address.
4. I have a written letter of approval from my landlord to have an animal in my home.
5. I agree to not let the animal run at large or become a public nuisance.
6. I understand that even though The Forest County Humane Society does their best at determining the breed of an animal, we cannot guarantee the accuracy of that determination.
7. I understand that the Forest County Humane Societyhas the right to accept or deny my request.
8. I realize that although the Forest County Humane Society will give your profile full consideration, the animal will go to the family that can provide the best home.
By signing below, I certify that the information I have given is true. I realize that any misrepresentation of facts may result in my losing the privilege to adopt a pet. I understand that the FCHS has the right to deny my request to adopt an animal for any situation that would be contrary to the shelters policies, in violation of state or local ordinances, or not in the best interest of the animal. I authorize the investigation of all statements in this application. I also authorize my veterinarian to release any information requested by the FCHS.
Signature: _________________________________________
Date:________________________
Approved by________________________________________ Case number: __________________
