WASHBURN COUNTY AREA HUMANE SOCIETY
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APPLICATION FORM
Personal Information
*
Indicates required field
What is the name and/or type of animal you are applying to adopt?
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Adopter's Name
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First
Last
Date of Birth:
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Email:
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Phone Number:
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Partner's Name
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First
Last
Partner's Phone Number
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Preferred Contact Method:
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Call (Adopter)
Text (Adopter) *message and data fees may apply*
Call (Partner)
Text (Partner) *message and date fees may apply*
Email
How many adults live in the home?
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How many children live in the home?
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Do you have any financial concerns? If yes, please explain. This will *NOT* impact your application's approval. We would love to share our resources with you if interested.
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Housing
You live in a...
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Apartment
Home
Duplex
Condo
Mobile Home
Other
If Other, please describe:
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Do you...
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Own
Rent, and I know what my pet policy restrictions are.
If Renting, please provide landlord's approval:
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Max file size: 20MB
Current Pet Information
**NOTE**
In the past, some applicants have not had the property owner’s consent and the pet had to be returned to the shelter. This is unfair to all concerned, but especially to the pet. We hope you will learn what your property owner’s pet policy restrictions are and abide by them appropriately.
Please list all animals that currently live in your household if applicable. Please include the type of pet, age, sex, if its spayed/neutered, and where the pet is kept.
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Are these pets up to date on their vaccinations?
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Yes
No
IF YES, PLEASE UPLOAD CURRENT VACCINATION RECORDS:
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Max file size: 20MB
If not, please explain why:
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Which veterinarian/clinic do you currently use or plan to use?:
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Clinic's Address:
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Line 1
Line 2
City
State
Zip Code
Country
General Information
Please describe why you’re interested in adopting this pet:
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How did you discover the WCAHS and/or the pet you are interested in?
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Have you adopted a pet from a humane society or rescue before?
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No
Yes
If yes, what was the organization's name?
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Does any member of your household have allergies to cats?
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Yes
No
Have you or any members of the household been convicted of crimes against animals?
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No
Yes
Are you familiar with the pet laws in your area?
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Yes
No (We recommend to look up your county/city’s ordinances regarding pets)
Pet Information
Where will your pet be housed during the day?
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Where will your pet be housed during the night?
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Where will your pet be house when they're alone?
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Please describe your plans for care while away on a trip:
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Please describe your plans for care If an emergency arises and you need to be away:
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Terms of Agreement
I grant the WCAHS permission to confirm any information provided in this questionnaire with any appropriate third party source, including landlords, veterinarians, public court records, etc. I certify that all the information on this application is true and accurate, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected.
It is understood that the WCAHS reserves the right to deny any adoption request at its own discretion. I also understand that this adoption application is the sole property of the WCAHS.
I certify that I agree to the above terms
*
Yes
No
Full Name
*
***NOTE***
If you
DO NOT get a confirmation message - the form was not submitted.
Please review and ensure you have filled out all required fields.
Submit
Home
Adopt
Adoption Application
Adoptable Pets
Volunteer
Volunteer Application
Foster
About WCAHS
History
Services
Donate
Membership Info
Stray Pets
Contact
Events
Vaccine Clinic