ADAMS COUNTY HUMANE SOCIETY
Placing animals in loving forever homes
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 and responsible 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 animals 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 18 years of age or older.
* Have a formal identification (i.e. Drivers License, etc.)
* Have the consent of all adults living in the household to adopt.
* Understand we reserve the right to deny or approve any application.
DOG:
CAT:
OTHER:
 Date of application:
Name of animal(s) you are interested in adopting:
Your name:
Month/year of birthday:
Drivers Licence #:
Mailing address:
Actual address if different:
Cell Phone #:
Home phone #:
Work phone #:
Your email address:
Mobile home:
 Condo:
 Live at parents or other arrangements:
Apartment:
 Other:
Do you live in a house?
Do you own or rent?
Landlords name and phone #:
* Note you must have landlord's
permission to adopt any animal.
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.)
Will everyone in the household be present for the adoption?
What household members will be
responsible for the care and feeding
of this/these pets?
Does anyone in your household have any allergies to animals?
How much do you anticipate spending yearly
on your adopted pet (vet care, food, toys, treats etc)?
Have you ever turned in a pet to a humane society, rescue or shelter?
If yes, please explain why.
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.
Are all animals you have now up to date on their rabies and distemper vaccinations?
Do you use heart worm preventative on your dog?
Are all your animals licenced?
If not, why?
Have you ever adopted from ACHS before?
Where are you intending on keeping the pet you are applying for?
Inside house, outside only, barn, other, please explain.
Where will you keep the pet when you are not home?
How do you plan to handle correcting the pet when
it misbehaves?
Behaviors such as:
Potting in the house?
Chewing?
Barking?
Biting?
Scratching furniture?
Fence jumping?
Not using the litter box?
Other inappropriate
behavior?
What Veterinarian
do you use?
Name of Veterinarian
and Clinic:
City Clinic is in:
Clinic phone #:
By signing or submitting this form, I certify that the information I have given is true and I realize any misrepresentation of the facts may
result in my losing the privilege of adopting a pet. I understand that the ACHS has the right to deny my application for any situation that
would be contrary to the best interest of the animal, ACHS policies, or state laws. I authorize my vet to release any information requested
by ACHS. I understand that ACHS does not warranty the temperament or health of any animal and agree to hold them harmless.
Signature:
Comments: