Application Form – South Wood County Humane Society

If you are human, leave this field blank.

Date *

Animal Type *

Animal Name *

Name - First and Last and Middle Initial *

Date of Birth *

Address *

City *

State *

Zip Code *

Primary Phone Number *

Secondary Phone Number

Do you give SWCHS permission to release your phone number to 24PetWatch? *

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

Drivers License Number *

Email Address

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

Email Sign Up

Please check this box if you would like to receive emails from South Wood County Humane Society

Please check this box if you would NOT like to receive emails from South Wood County Humane Society

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) ? *

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. *

Please provide name and phone number of land lords if applicable *

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

Gift

Companion for you

Companion for another pet

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

Other adults

Children

Seniors

How long are you gone during the day? *

When gone, where will this pet be kept? *

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

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.