Adoption Application Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Email *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWhat type of dog/cat are you looking for? (size, age, sex, etc.)What type of accommodation do you live in? (house, apartment, mobile home, etc.)Who owns your accommodation?If renting, please provide landlord's contact information:What pets do you currently own?LayoutPet Name & BreedAgeSexSpayed/Neutered?Layout (copy)Pet Name & BreedAgeSexSpayed/Neutered?Layout (copy) (copy)Pet Name & BreedAgeSexSpayed/Neutered?Why do you want to adopt a dog/cat?How many people live in your household and what are their ages?On an average day, how long would your dog/cat be left on its own and why?Where will you keep your pet during the daytime and nighttime?Do you have a fenced in yard?YesNoPlease describe the type and height:To feed, vaccinate, license, and provide medical care for this pet, how much do you anticipate spending yearly:What behaviors, if any, can you just not tolerate, or do you feel would be difficult for you to manage?Would you like more information on crate training your new dog?Name and telephone of veterinarian you are currently using or plan to use:What is your opinion on spaying/neutering of companion animals?Would you be willing to allow a Humane Society representative to conduct a home visit?Please list a reference that is familiar with your relationship with animals:How did you hear about the Humane Society of Stillwater?I understand that completing this form does not guarantee I will receive an animal from the Humane Society of Stillwater. The Humane Society of Stillwater reserves the right to refuse/deny adoption to individuals who do not meet our adoption criteria.LayoutSignatureClear SignatureDate / TimeSubmit
