Adoption Application

Welcome and thank you for adopting a pet from the Humane Society of Southern Wisconsin!

To complete this application, you must:

Be at least 18 years old.
Have formal identification.
Understand that we have the right to accept or deny any application.

*Required

Contact Information

*Name

Got someone picked out? Pet you want to take home:

*Street address

*City

*State

*Zip

*E-mail

*Home Phone

Alternate Phone

*D.O.B.

*Driver's License (or other formal ID)

If you live outside of Rock County, please list the county you reside in:

*Do you live in a:
House Apartment Condo Mobile Home
Other

*Do you:
Rent Own Live at parent's or relative's home

Emergency Contact Information

*Microchip Emergency Contact (Someone outside of your home)

*Home Phone

Alternate Phone

Consent

*Yes, I consent to the release of my Microchip contact information to anyone who finds my pet.
*No, I prefer that communication only be through 24PetWatch Microchip ID System.

Household Information

*Number of People in household

*Number of Pets in household

*People in Household

*Pets in Household

By signing below, I certify that the information I have given is true, and I realize that any misrepresentation of facts may result in loss of adoption privileges.

All information contained in this application will remain confidential and the property of the Humane Society of Southern Wisconsin.

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