Application Form

Congratulations on your decision to adopt an animal companion! South Wood County Humane Society is happy you are considering adopting from our shelter. Our goal is to find permanent, loving and responsible homes for the animals in our care.  We do not place holds on any animal for adoption due to kennel space. We strive to match the best animal for your situation and the best situation for that animal. Please complete all parts the application, as incomplete applications will not be processed. In order to be considered for adoption, you must:

• Be 21 years of age or have a co-signer present at time of turning in application and adoption if approved.
• Have formal identification (ex. Drivers License)
• Current pets must be up to date on vaccinations, unless verified with your personal vet that current pet(s) cannot have a certain vaccine due to medical issues and/or health of animal.
• SWCHS will check with landlords for approval of pets in rental homes, apartments and mobile home parks. Parental permission must be granted if you live in their home at time of application.
• In the matter of multiple applications received for one specific animal, SWCHS will go through all the applications and contact all applicants when their application is approved. All applicants will be informed about the multiple applications for the one said animal. Adoptions are based off of best fit home and the availability of the applicants schedule to meet with and/or adopt said animal.

Adoption Questionnarie

Date *

Animal Type * Canine Feline Other

Animal Name (if undecided, please put "OPEN") *

Your Name (First, Last, Middle Initial) *

Are there any previous names that you went by? (maiden name, previous name before a name change, etc.) *

Drivers License Number *

Date of Birth *

Address *

City *

State *

Zip Code *

Primary Phone Number *

Secondary Phone Number

Email Address

In order to qualify for 30 days of free 24PetWatch animal insurance a valid email address must be provided.

I would like to receive emails from the South Wood County Humane Society

Yes

No

Do you give SWCHS permission to release your phone number to 24PetWatch? * Yes No

In order to qualify for 30 days of free 24PetWatch animal insurance you must agree to release your phone number to 24PetWatch.

Would you like to opt into the Petco Pals Rewards Program? * Yes No

Petco Pals Rewards will send you automatic emails regarding promotions happening within the Petco Franchise (sales, updates, etc.)

Emergency Contact Person, other than yourself, who we may contact if your pet goes missing *

Emergency Contact Person Address *

Street Address, City, State and Zip Code

Emergency Contact Person Phone Number *

Do you (select) ? * Rent Own Live with parents/relatives

Renters, have you consulted with your landlord yet about having a pet? We highly recommend that you speak with your landlord prior to adoption as they might have size and breed restrictions, limits on number of pets and/or pet fees. * Yes No Will be soon N/A

Landlord Name *

If you own your property, please put "N/A"

Landlord Phone Number *

If you own your property, please put "N/A"

Tell us about members of your new pet's household. Check all that may apply.

Other adults

Children

Seniors

Please provide FIRST and LAST name of all adults living in the home (18+) *

Is this pet a (check all that apply): *

Gift

Companion for you

Companion for another pet

OtherOther

How long are you gone during the day? *

When gone, where will this pet be kept? *

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Current Pet Information

Tell us about any pets you currently have at time. (Include Name, Breed, Age, Gender and Time of Ownership and Spayed or Neutered.) *

Example: Penny, Beagle Mix, Female, 5 years, Spayed

What veterinarian do you currently use for your pets?

Have you ever had to rehome a pet or surrender a pet to a humane soceity/rescue? If yes, please explain *

Any answer to this question does NOT disqualify an applicant. We ask this as a part of our approval process so we can better assist with finding a perfect match for your home.

Any other information you would like to share?

Do you have any questions?

Adoption fee includes:

• Spayed/Neuter
• Microchip
• Vaccinations
• De-worming
• Flea Control
• Feline FIV/FELV
• Canine 4DX test

South Wood County Humane Society has the right to accept or deny this application for any reason.

A completed application does not guarantee an approved application. I certify that I am at least 21 years of age and the information given is true. I authorize any and all verifications of statements made in the application. I recognize that any misrepresentation of facts may result in losing the privilege of adopting a pet.

I understand vaccines, vet care and proper nutrition can cost $300-500 per year and I agree to financially provide for this animal during its entire lifespan which may be 20 years or more.

I also understand SWCHS has the right to do a follow up visit and take pictures showing proper shelter is being provided for any animal kept outside. If this animal becomes ill, injured, or lost, I will contact the SWCHS immediately.

I also sign that I understand how the adoption process works, agree to complete any spay/neuter requirements and pay fees involved with adoption.

By clicking the "Submit" button below, I agree that the information listed above is correct and that I understand all terms and conditions.

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