Adoption Application - Humane Society of Southern Wisconsin

Adoption Application

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

To complete this application, you must:

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Be at least 18 years old.

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Have formal identification.

Understand that we have the right to accept or deny any application.

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Contact Information

Name *

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

Street address *

City *

State *

Zip *

E-mail *

Home Phone *

Alternate Phone *

Date / Time *//

Driver's License (or other formal ID) *

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

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.

Testing

Would you like to pay an additional $25.00 for FeLV Antigen and FIV Antibody Testing? (Cat adoptions only)

Declawing

Are you considering declawing? (Cat adoptions only)

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.