I'm looking for: *

Cat

Dog

Applicant's Legal Name *

First Name

Last Name

Applicant's Date of Birth *

MM

DD

YYYY

Co-Applicant's Legal Name

First Name

Last Name

Co-Applicant's Date of Birth

MM

DD

YYYY

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Main Phone Number *

(###)

###

####

Alternative Phone

(###)

###

####

We live in a: *

House

Apartment

Condo

Mobile Home

Townhome

Do you rent or own your home?

Rent

Own

Have you spoken to your landlord about getting a new pet?

Yes

No

Full Name of Landlord or Property Manager

First Name

Last Name

Phone of Landlord or Property Manager

(###)

###

####

Are you over the Age of 65 or a military veteran (active, retired, or honorably discharged)?

We have a grant program to help subsidize adoptions for seniors (65+) and military veterans. This program offers a $50 discount once per year on adoptions fees. This discount cannot be combined with other offers and does not apply to adoptions for DCHS pets at PetSmart or UWRF.

Yes

No

Have you ever adopted from (or applied to adopt from) DCHS?

Yes

No

Are you committed to spend 12+ years providing health care, food, grooming, & compassionate attention to a new pet? *

Yes

No

Do you have any recent or upcoming life events/changes?

New Child/Baby

Moving Homes

Vacation

Separation or Divorce

New Job or Deployment

The primary caretaker is: *

Employed Full-Time Outside of the Home

Employed Part-Time Outside of the Home

Stay Home (or Work from Home)

Retired

Student

This pet will be: *

Inside Only

Outside Only

Inside/Outside

Do you plan on declawing? *

For cats only. For dogs, please select "No"

Yes

No

What issues or problems would make you want to return this pet to the shelter?

Our staff understand the variety of reasons people have for returning a pet to a shelter, and we do not judge applicants for those reasons.

Housetraining/Litterbox Issues

Chewing

Digging

Biting/Scratching People

Pulling on Leash

Inappropriate Jumping

Aggression

None

Are your pets currently up-to-date on their vaccinations?

Yes

No

Not sure

What is your current veterinarian's phone number?

(###)

###

####

DCHS requires that all adopted pets be spayed/neutered. Are you prepared financially and willing to comply with this policy? *

Yes

No

Do you understand and agree to the following terms? *

The undersigned applicant(s) hereby grants the Dunn County Humane Society, Inc. (DCHS) permission to confirm any information provided in this application with any third party source including landlords, veterinarians, law enforcement, online sources, property records, etc. The information obtained will be held in confidence and used only by the DCHS for purposes of this adoption application. The DCHS does not discuss application decisions with anyone except the listed applicant or co-applicant. The applicant(s) certify that all the information on this application is true and complete and understand that if any false information, omissions, or misrepresentations are discovered, the application may be rejected. The information on this application is considered unchangeable, once it is submitted for consideration. Reapplying with changed or different information voids all applications from consideration. It is expressly understood that this adoption application is the sole property of the DCHS and the DCHS reserves the right to deny any adoption at its own discretion. Applying does not guarantee approval nor does it reserve any animal from going to another applicant.

Yes

Applicant's Signature *

Please type your full name to agree to these terms

First Name

Last Name

Date *

Please use today's date to agree to these terms

MM

DD

YYYY