Adoption Application - Humane Society of Burnett County

Which animal are you interested in?*

Email*

Home Phone

Cell number*

Date of Birth*

Landlord name and phone number or email

Employer

Employer Phone Number

Source of income if unemployed

Full legal name and birth date of each household resident over the age of 18

Ages of children (under 18) living in the home

Emergency Contact Name (An alternate contact for microchip registration in case you cannot be reached)

Emergency Contact Phone Number

Describe your interest in adopting this animal

Describe any expected major events/changes to your household in the next 6 months (moving, travel, marriage, pregnancy, etc.)

It may take several weeks for your new pet to feel comfortable in their new home; how do you plan to ease their transition?

How often do you travel? Describe your plans for care when traveling

Where will your pet be housed?

Where will your pet be kept when alone?

How often will your pet be left alone?

Describe your plans for correcting the following behaviors

Excessive barking

House-soiling

Chewing

Scratching/clawing

Have you ever had to give up a pet as an adult? If so, explain

Please tell us about the animals (including farm animals) you have owned in the last five years. Include animals you still own.

If any pets are not spayed/neutered or current on vaccinations, explain reasoning

Name of vet clinic you use

Vet Phone Number

Please provide two personal references that do not live with you that we may contact on your behalf regarding this adoption. If you have no references, please explain

Any other information you would like to share with HSBC?

I grant the Humane Society of Burnett County, Inc. permission to confirm any information provided in this questionnaire with any appropriate third party source, including landlords, veterinarians, public court records, etc. If I am approved to adopt a cat or kitten from HSBC I agree that this cat or kitten will not be declawed for any reason. I understand violation of this agreement will result in loss of ownership. I certify that all the information on this questionnaire is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered my request to adopt may be rejected. It is understood that the Humane Society of Burnett County, Inc. reserves the right to deny any adoption request at its own discretion.

E-Signature

Date

We truly hope we can match you with the right pet, which is why we ask so many questions and need to verify all types of information. It’s traumatizing for animals when they come to the shelter no matter what their circumstances. It is our job to find the best possible home for them. Thank you for your patience and understanding.

Phone

This field is for validation purposes and should be left unchanged.