Dog Adoption Application

Congratulations on your decision to adopt an animal companion for your family.
Our goal at Adams County Humane Society is to find permanent, safe, loving, and
responsible homes for the animals in our facility. We will work with you to help
you find the dog that best fits in with your lifestyle and family.

Adams County Humane Society Dog Adoption Application

ADOPTION REQUIREMENTS

* Complete an adoption application.
* Be a Wisconsin resident and age 21 years or older.
* Have proper identification that has your photo and lists your date of birth.
* Current pets must be up to date on rabies and distemper vaccinations.
* Where applicable, ACHS will check with landlords or parents for approval.

EVERY ENTRY MUST BE COMPLETED OR THIS APPLICATION WILL NOT SUBMIT CORRECTLY!

Enter "N/A" if a question does not apply to you.

* Indicates required field

Your First Name - Middle Initial - Last Name *

Date of application *

Name of Dog You Are Applying For *

Your Date of Birth *

Partner's First and Last Name - Enter NONE if this does not apply. *

Partner's Date of Birth - Enter NONE if this does not apply. *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

List Someone Who You Trust to Be Your Dog's Microchip Emergency Contact In Case Your Dog Runs Away - Not You or Your Partner *

First

Last

Emergency Contact Phone Number *

Financial/Employment

List all sources of income for your household. You do not need to enter any amounts. *

Employment Status: *

Household

Do you own or rent? *

Name of Landlord or Parent - Put "N/A" in each blank if you do not rent. *

First

Last

Phone Number - Put "N/A" if you do not rent. *

Please list the full name and age of all people living in the home where this animal will reside. Include the date of birth for everyone 18 and older. Enter NONE if you live alone. *

Have you ever adopted from ACHS before? *

Have you ever surrendered a pet to a humane society, rescue, or shelter? *

If yes, please explain why. If this does not apply to you enter NONE *

Does anyone in the home have allergies? *

Yes No

Have you owned a dog or cat before.? *

Yes No

My new dog needs to be good with kids: *

Under 7 Years of Age Over 7 Years of Age Of All Ages Not Applicable

My new dog needs to get along with other dogs. *

Yes No

My new dog needs to get along with cats. *

Yes No

How many hours a day will your new dog be alone at home? *

4 Hours or Less 4 - 9 Hours More Than 9 Hours

My home is best described as: *

Peaceful & Quiet Busy & Happy Chaotic

When I am gone my new dog will be: *

How will you take your new dog out to the bathroom? *

Fenced in Yard Dog Run Tied Out On a Leash Take Him/Her for a Walk

The most important trait I want in a new dog is *

Do you have livestock at home? *

Do you have poultry at home? *

I am comfortable training my dog to improve manners: *

What is your definition of disciplining a dog? *

Tell us about your pets at home (check all that apply): *

I have one or more dog(s) I have one or more cat(s) I have one or more small animal(s) I do not currently have other pets.

List the following for each dog: name, male/female, age, breed, and if they are spayed/neutered. Write NONE if you don't have a dog living with you. *

List all your cats, ages, and if they are spayed/neutered. Write NONE if you don't have a cat living with you. *

If any of your pets are not spayed/neutered explain why. Write NONE if this does not apply. *

Veterinarian Clinic's Name *

First

Last

Veterinarian's Phone # *

ACHS offers free pet insurance for one month with adoptions. This only covers illness or injury and does not cover routine visits. Would you like this insurance? *

Yes No

Please read each line item and then check each box, indicating that you understand the following conditions of adopting from our shelter: *

ACHS has the right to accept or deny this application for any reason. No explanation will be given for a denied application. We choose the home we feel is the best home for the animal based on the application and the interaction with the family, regardless of the order applications are received. If there is another dog living in your home and you want to adopt a dog a meet and greet is required to make sure this is a good fit for all of the dogs. A filled out application does not guarantee your application will be approved. Information provided is true to the best of my knowledge. Falsifying information will result in a denial of my application. The adoption process and the adoption fee involved with adoption. ACHS does not guarantee the temperament, age, breed or health of any animal and agree to hold ACHS harmless for any damages the animal may do to any person or property. ACHS has the right to come to your home and complete an animal welfare check for all animals adopted from our fdacility.

I hereby state I have read the above statements and agree to abide by these conditions.

Type your name below as an Electronic signature. *

Today's Date *

We have had problems with receiving submitted applications. Until the problem is resolved, after clicking the submit button below, please email [email protected] to let us know you have submitted an application. Thank you for your patience!

Before clicking SUBMIT, check your application. EVERY box must be filled in. If a question does not apply to you, enter N/A.

**ACHS reserves the right to deny any adoption application received.

Submit