In order to be considered for an adoption today you must:
- Be 18 years of age
- Have the knowledge and consent of all adults living in your household
- Have verifiable identification
- Understand that theArnell Memorial Humane Society has the right to
deny your application
  

So that we may be assured that the animal you want to adopt will be best suited for you, your home and lifestyle, we would like you to provide us with the following information.

This form should take approximately 10-20 minutes to complete. Thank you for your cooperation.

NOTE:. In order to process this application, ALL eight fields marked with * MUST be completed.

 

Applicant:   
>>This online form will only work if all of the following 9 * fields with are correctly entered<<
*Animal Interested in Adopting:
*Name:
*E-mail address:
*Street Address:  *Home Phone:
*City: *County: *State: *ZIP:
How many years have you lived at the above address?
Cellphone:
Previous address (if less than 5 years)         Street
City County:
State: ZIP:
Work # D License#
Date of Birth:
Co-applicant (Spouse or Significant Other):      
First Name:

 Last Name:

Date of Birth?
 
     



Do you... rent home own home live with parents?

Is Your Home ... a house an apartment duplex/condo trailer Home residential rural

If you rent, do you have the landlord's permission to own a dog? Yes No
      Who is the landlord?

   What is the landlord's phone number?


   If living with parents, please supply: Names  Contact Information

Other Family Members:  
How many people are currently living at this residence?
Men:
 number? ages?
Women:
 number? ages?
Girls
 number? ages?
Boys:
 number? ages?

Please tell us the names of the people in your household:
Are the people in your home experienced with dogs? Yes No
Is everyone in the household agreeable to getting a new dog? Yes No

Please check any of the following reasons for adopting this dog:   family pet   child's pet   watchdog  companion   hunting dog   guard dog for business   companion for other pet   gift   other - please specify:

Do you plan on moving in the next 6 months?
Yes No 		Would your pet go with you if you moved?
Yes No
List animals you currently own or that are in your care/house and those you have owned in the past five years, if you need more room list in comment box below:
Dog
Cat
Other 		Name

If other, what:

Breed:
Male
Female

Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:
Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 		Breed:

Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:

Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:

Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Have you adopted from our AMHS Shelter before? yes no
If yes, when did you adopt? If yes, where is the pet today?
Have you ever surrendered a pet to AMHS? yes no If yes, when? Why?
Have you ever surrendered a pet to another Humane Society? yes no  
What veterinary hospital do you use (or do you plan to use)?
Are your current pets up-to-date with their vaccinations?

yes no      don't know

don't have pets yet
Under whose name are the veterinarian hospital records?
Please list your veterinarian's phone number


Do you foresee any major changes in your life in the next 15 years (average lifespan of a dog) such as marriage, childbirth, health problems due to age, going away to college? Yes No  -  If yes, please explain:

Can you provide a permanent home for this dog for 10-15 years? Yes No

Who is going to be the main pet caregiver?

What best describes the main pet caregiver?  (check all that apply)
Retired
Stay at home parent
Employed Part/Full time ...........max. hours/day away from home?
College Student
Child/Adolescent
Where does your current dog stay when home alone during the day?
Where will your new dog stay when home alone during the day?"
Where do current pets sleep at night?
Where will the new dog sleep at night?

Do you have a fenced yard? Yes No
Is anyone in your home allergic to dogs ? Yes No

Have you ever given a dog up because it didn't work out? Yes No
If so, please explain the circumstances and what happened to it:

How do you intend to train this dog?  On my own  Obedience class  Other 
If other than obedience class, please tell us more about your training plan: 
How do you plan to exercise this dog? 
Are you familiar with crate training?  Yes No
Would you crate train this dog if it was necessary?  Yes No
It may take your new pet two weeks or longer to adjust to its new home. Are you prepared to allow for this adjustment period? Yes No
On an average day, how long will your dog be left without human companionship?
Are you familiar with the pet laws in your area? Yes No
How do you plan to housetrain(potty-train) your dog/puppy?
Are you familiar with the needs of the breed you have chosen?
Yes No

House training, excessive barking, digging, chewing (teething) on furniture and household objects, and jumping on people (these are very normal canine behaviors) are some of the issues that you may have to deal with.

Yes No
What type of ID will your dog wear?
Will you use a leash to walk your dog? Yes No
Are you financially prepared to properly care for a dog ($500-$600/yr)? Yes No
Please enter any additional comments that you may have regarding this application:

For applicants outside of Pok County:
References, outside of your family:
  Name Phone Number
1
2
3

Please list your area shelters and their phone numbers
  Shelter Phone Number
1
2
3

The undersigned applicant hereby grants the Arnell Memorial Humane Society permission to confirm any information provided in this application with any appropriate third party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by the Arnell Memorial Humane Society for purposes of this adoption application.

I certify that all the information on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I also understand that this adoption application is the sole property of the Arnell Memorial Humane Society.

It is specifically understood that the Arnell Memorial Humane Society reserves the right to deny any adoption application at its own discretion.

Typing your name below will serve as legal signature.
By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue dog and possible removal of said dog from my home. Applicant must be 18 years of age or older. We reserve the right to refuse any applicant.
Date: Driver's license #: REQUIRED FIELD

If the form doesn't work, make sure that the 8 fields marked with an * are filled in.

Please carefully enter this code. This helps prevent spam and must be entered to proceed!
   

IF you have problems with this ONLINE form, Please follow the instructions below.

IF you have problems with this ONLINE form:
click HERE to print an adoption form
and

Snail Mail it to us at:

Arnell Memorial Humane Society
P. O. Box 314
185 Griffin St. E.
Amery, WI 54001.
715-268-7387