ADAMS COUNTY HUMANE SOCIETY
ADOPTION APPLICATION
P.O.Box 375 1982 11th ave.
Friendship WI 53934
608-339-6700
Congratulations on your decision to adopt an animal companion for your family. The Adams County Humane
Society is happy you are considering adoption from our shelter. The goal of the ACHS is to find permanent,
loving, forever homes for the animals in our facility. We do not adopt on a first come served basis, do not hold
animals for adoption and our goal is to match the best animal for your situation. Please complete the
application completely, as incomplete applications will not be processed.
In order to be considered for adoption, you must:
* Be 21 years of age or if under 21 you must be a home owner. Proof of ownership may be required.
* Have formal identification (i.e. Driver’s license, etc.)
* Current pets must be up to date on vaccinations.
* Proof of homeowners insurance for adopters interested in bully breeds that accept the breed you are
interested in.
* ACHS will check with landlords for approval of pets in rental homes/apartments/condos. If you live at home
with your parents we will have to call them as well as they are the home owners.
If you do not hear from us within 24 hours please call ACHS at 608-339-6700 to make sure we received your application.
With some computer systems they are not getting to us.
OTHER:
CAT:
DOG:
Date of application:
Name of animal(s) you are interested in adopting:
Month/year of birthday:
Your name:
Name of Spouse or Sig other:
Mailing address (please include
your town, state and zip code):
Actual address if different (please
include your town, state and zip code):
Drivers Licence #:
Home phone #:
Work phone #:
Cell Phone #:
Your email address:
Do you live in a house?
 Apartment:
 Mobile home:
 Condo:
Live at parents or other arrangements:
Do you rent your home?:
Do you own your own home?
Landlords/ Parents name and phone #:
* Note - We will call landlords (or parents if
you live at home) as part of the adoption
application process, please make sure you
have permission to have an animal.
Name/ number of your Vet Clinic:
* Note - We will be calling your vet clinic to verify
your current or recent pets are or have been kept
up on their rabies and distemper vaccination as
part of the adoption application process.
Adams County Humane Society offers one month free pet insurance with adoptions. This does not cover
routine visits only if the adopted animals were sick or injured.  Would you like this insurance? Yes or No  
If you check yes, please make sure your email info has been filled in above.      
List all people (name,month and year born) who live in household (including those who visit regularly, i.e. Children who
you have shared custody of etc.)
List all people (name, age) who live in household (including those who visit regularly, i.e. Children who you have shared custody of etc.)
Will everyone in the household be present for the adoption?
Does anyone in your household have any allergies to animals?
Have you ever turned in a pet to a humane society, rescue or shelter?
If yes please explain why.
Have you adopted from the Adams County Humane Society?
Have you owned a dog/ cat before?
I want an inside dog/cat, inside/ outside or outside only?
My dog/cat needs to be good with all age kids, kids under 7 or kids over 7?
When I am gone, my dog/ cat will be in a crate, loose in the
home, confined to a room or outside?
I want my dog/ cat to be playful
I want a guard/watch/protective of me, dog: Yes or No?
My home is best described as, Quiet/ Moderately active/ Chaotic?
I am interested in a dog/ cat with "special needs" (medical or behavioral). Yes or No?  
My dog/ cat needs to get along with dogs?
My dog/ Cat needs to get along with cats?
I have livestock at home? Yes or No. If yes what kind?
When I am home I want a dog/ cat by my side at all time, some of the time or a little of the time?
I am comfortable doing training with my dog to improve
manners, No training, some training or a lot of training?
My dog/ Cat would be alone 4 hours or less, 4-8 hours or more then 8 hours?
I will attend obedience classes with my dog/ puppy, Yes or No?
I want a dog to compete in competitions with me?
What is your definition of disciplining a dog?
The most important trait in my dog/ cat would be:
Please list all pets you have had in the past 5 years.
Include- Name, breed, age at time they were no longer with you, male or female, spayed or neutered, declawed (if cat),
where they were kept (inside, outside) and how long  they lived with you.
What animals do you currently have living in your household?
Include- Name, breed, age, male or female, spayed or neutered, declawed (if cat),
where they are kept (inside, outside) and how long  they have lived with you.
If your current pets are not spayed or neutered, please list the reason why:
ACHS has the right to accept or deny this application for any reason.

We choose the home WE feel is the best home for the dog based on the interaction/application with the family and the other dogs. A filled out
application DOES NOT guarantee your approval. I hereby state that information provided is true to the best of my knowledge. Falsifying
information will result in a denial of my application. I also sign that I understand how the adoption process works and the fees involved with
adoption. I understand that if the dog I have chosen is not altered at the time of the applications filled out, I must wait until the surgery is
performed before the dog/cat can go home with me. Animals will be held no more than 1 day after an application is approved. I understand that
ACHS does not guarantee the temperament or health of any animals and agree to hold ACHS harmless.
Signature of Applicant:
Comments:
If you do not hear from us within 24 hours please call ACHS at 608-339-6700 to make sure we received your
application. With some computer systems they are not getting to us.