Adoption application
Please copy and paste the application below into a email and send to:


701 Industrial Parkway
PO Box 57
Crandon WI 54520
Phone: (715) 478-2098
Federal Tax ID# 39-1812068


Full name_________________________ Previous name_____________________

Date________________             Date of Birth_____________________________

Address ___________________________________________________________

City and State___________________Zip Code____________________Phone___________

Previous Address is space below or mailing address



Email address: __________________________________________________________________


How long have you been employed? _____________

 Employer Phone_____________________________


If less than one year who was your previous employer? _____________________


Spouse/Roommate_____________________age       _     Phone____________________

Spouse/Roommate Employer________________________Phone_____________

Length of time at this Employer:______________________Supervisor:____________

Contact number:______________________________________________


Please provide Two Non-related personal references who can speak to your ability to care for a new pet:



Do you own or rent your home?__Own  / Rent   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 ______________________  

Names and birth dates of others in the Household: ________________________





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 or other citations or convictions that may cause your application to be denied?   _________Please explain if yes: __________________________________________________________________





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?  _________________

If you do not have a veterinarian, who do you plan on using? __________________


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? ___________________________________________________________________



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:

  1.  Animal type and name__________________ Age__________ Altered Y/N

  2. Animal type and name__________________ Age__________ Altered Y/N

  3. Animal type and name__________________ Age__________ Altered Y/N


Do you have a fenced in yard?  Y/N      If No, how are you planning on taking animal outside?



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? _________________________________


 Please tell how you would discipline your animal if it went to the bathroom on your floor or discipline for any other reason: ________________________________________




Please describe any situation that would make you feel like you would surrender your pet?




Please tell us any passed experience you have with this breed or other similar experiences:





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.

  • I am at least 18 years old.

  • I have consent to adopt an animal from all adults living in my home.

  • I have verifiable identification showing my present address.

  • 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.

  • I agree to not let the animal run at large or become a public nuisance.

  • 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. 

  • I understand that the FCHS has the right to accept or deny my application for adoption.

  • 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.




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 seven 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, using any background check sites etc.  I authorize my veterinarian to release any information requested from the FCHS.


Signature _______________________________Date________________


Manager Signature_______________________________Date_________________