Adoption application
Please copy and paste the application below into a email and send to:
FOREST COUNTY HUMANE SOCIETY
ADOPTION APPLICATION
701 Industrial Parkway
PO Box 57
Crandon WI 54520
Phone: (715) 478-2098
Email: foresthumane1@yahoo.com
Federal Tax ID# 39-1812068
Full name_________________________ Previous name_____________________
Date________________ Date of Birth_____________________________
Address___________________________________________________________
State___________________Zip Code____________________Phone___________
Previous Address is space below or mailing address
Email address: __________________________________________________________________
Employer___________________________________________________________
How long have you been employed? _____________
Employer Phone_____________________________
Supervisor_____________________________
If less than one year who was your previous employer? _____________________
__________________________________________________________________
Spouse/Roommate______________________Phone________________________
Spouse/Roommate Employer________________________Phone_____________
Please provide Two Non-related personal references who can speak to your ability to care for a new pet:
Name_________________________Relationship_________Phone____________
Name_________________________Relationship_________Phone____________-
Do you own or rent your home?__Y / N___If renting Landlord Name and contact information: _________________________________________________
I live in a House / Apartment / Duplex / other
How many members live in your family? Adults: ____________ Children under the age of ten? ___________ Children over the age of ten? _______________
Ages ______________________
Has anyone in your household ever been cited or convicted of an animal related crime [ neglect, abuse, running at large etc.] or any other criminal citations or convictions that may cause your application to be denied? _________Please explain if yes: __________________________________________________________________
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I am interested in adopting: [animals Name]______________________________
What factors made you decide to apply for this animal? _____________________
___________________________________________________________________
Current or Past Veterinarian____________________________________________
Other Veterinarians__________________________________________________
Veterinarian Address_________________________________________________
Veterinarian Phone and Clinic Name: ____________________________________
How long have you received services from this veterinarian? _________________
How many hours a day will the animal be left alone? __________ How will the animal relieve itself? ___________________ Where will the animal be kept while home alone? ___________________________ Please describe any physical /mental activities that you plan on engaging with your pet? ___________________________________________________________________
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I would like to adopt a pet for [ Please check all that apply] Companion Gift For a Child Therapy Animal Hunting….Protection To breed Other:_______
Please list any other pets in the home:
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Animal type and name__________________ Age__________ Altered Y/N
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Animal type and name__________________ Age__________ Altered Y/N
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Animal type and name__________________ Age__________ Altered Y/N
Are all of your animals current on their rabies & Distemper/Combination vaccinations? Y/N Can you provide proof of vaccinations? Y/N
This animal will be kept in: House/Garage or Barn Outside/Kennel/Outside on Chain Crate
How do you plan on training the animal? _________________________________
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Please tell how you would discipline your animal if it went to the bathroom on your floor or discipline for any other reason: ____________________________
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Please describe any situation that would make you feel like you would surrender your pet? __________________________________________________________
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Please list any additional information that you may feel relevant to help us process your application:
Please read each of the following and sign below to acknowledge that you agree with all statements.
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I am at least 18 years old.
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I have consent to adopt an animal from all adults living in my home.
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I have verifiable identification showing my present address.
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I have a written letter of approval from my landlord to have an animal in my rented home. I also will allow the FCHS to speak with my landlord about any restrictions on weight/breed etc.
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I agree to not let the animal run at large or become a public nuisance.
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I understand that even though the FCHS does their best at determining the breed of an animal, we cannot guarantee the accuracy of this determination.
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I understand that the FCHS has the right to accept or deny my application for adoption.
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I realize that although the FCHS will give this application full consideration, ALL animals will go to the home that is determined to be the best match for their individual needs.
ADOPTION APPLICATION DISCLAIMER
The FCHS will not delay the processing of my adoption application, as it is our goal to place our animals in a timely manner. Please understand that we receive applications via the internet, US mail and in person. You may not be the first and / or only applicant on any given pet. Multiple applications for one pet can result in an extended processing time while we work to find the best fit, based on the pet’s individual needs and history. The FCHS reserves the right to refuse to adopt our animals to anyone for any reason. We strive to find safe, permanent placement for our pets. If, in the course of our processing of your application, or through observations during any visitations, we are not confident that the match would be successful, we may deny adoption at any point of the adoption process. The FCHS will not adopt out any pet if deem to be unadoptable due to severe illness or behavioral instability. You are adopting your pet from the FCHS as is and assume responsibility for its health and wellbeing. While any pet adopted may be returned to us for ANY REASON at ANY time, refunds will only be given within thirty days of adoption minus the surrender or any pre- arranged fee. We ask that you submit the following information, along with the answers provided in this application. Visits from all members in the household, proof of vaccination for current pets [ via paper records or by the FCHS contacting your veterinarian] Any other pets that live in the household must be properly introduced to canines that are to be adopted. I certify that the information I have provided is true and I recognize that any misrepresentation of fact may result in loss of adoption privileges. I authorize and understand that veterinarians, other Humane societies, landlords, etc. may be contacted. The FCHS does not adopt pets as gifts for any reason. This application becomes property of the FCHS.
By signing below, I certify that the information I have given is true. I realize that any misrepresentation of facts may result in my application being denied and I will lose the privilege to adopt a pet. I understand that the FCHS has the right to deny my request to adopt an animal for any reason or situation that is contrary to shelter policies, in violation of state or local ordinances or laws, or is not in the best interest of the animal. I authorize the investigation of all information provided in this application. I authorize my veterinarian to release any information requested from the FCHS.
Signature _______________________________Date________________