Adoption FormPlease enable JavaScript in your browser to complete this form.Name *FirstLastPhoneEmail *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict 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? *Please SelectHouseApartmentMobile HomeOtherWho owns your accommodation? *If renting, please provide Landlord's contact information:What pets do you currently own?Name:Breed:Age:Sex:Spayed/Neutered?Please SelectYesNoName:Breed:Age:Sex:Spayed/Neutered?Please SelectYesNoIf Necessary Please List Additional Animals Here:How many people live in your household and what are their ages? *On an average day, how long would dog/cat be left on it's own and why? *Where will you keep your pet during daytime and nighttime? *Do you have a fenced yard? *YesNoIf yes, please describe the type and height:To feed, vaccinate, license, and provide medical care for this pet, how much do you anticipate to spend 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 info on crate training for your new dog? *Name and telephone of veterinarian you are currently using or plan to use: *Would you be willing to allow a Human 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: *Please Sign: *Date: *Submit