You may print this form, fill it out and bring it into our office. Please call first. (715-478-2098)

OR:

Copy and Paste the form text below into an email addressed to

Fill out the form right within the email and send.

Do not mail.

This is time sensitive info and we need this form back ASAP if you are interested in adopting from us.
 

 

FOREST COUNTY HUMANE SOCIETY

701 Industrial Parkway

PO Box 57

Crandon WI 54520

Phone: (715) 478-2098

Email:

Federal Tax ID# 39-1812068
 

Full Name (First, M.I. Last) ______________________________________________________
 

Address ___________________________________ City ______________________________ State _________ Zip _______

Email Address_______________________________________________________

Phone # _________________________

 

Employer ___________________________________
 

Work phone ______________________________
 

Spouse/Roommate ___________________________________
 

Employer __________________________ Work Phone ______________________________
 

Veterinarian __________________________________________ Vet. Phone ____________________

 

Please provide two non-related references:
 

Name and Relationship  ______________________________________________
 

Phone __________________________
 

Name and Relationship ______________________________________________

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 (Name and Breed): _______________________________
 

Do you currently live in a (X one): House ___, Apartment ___, Condo ___, Trailer ___, Duplex___
 

Do you own or rent your home? (X one):Own____ Rent____
 

If rent, Landlord Name and Phone Number: _______________________________________
 

How many members in your household? Adults____ Children (over ten) ____ (under ten) ____
 

Have you ever surrendered an animal to a shelter before? Yes ____ 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 and am aware of leash and licensing laws in my town/county.

6. I understand that even though The Forest County Humane Society does their best at determining the breed and age of an animal, we

cannot guarantee the accuracy of that determination.

7. I understand that the Forest County Humane Society has the right to accept or deny my request and 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: _______________

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