Auglaize County Humane Society Adoption Application

About You

Salutation:    Mr. Mrs. Miss Ms. Dr.   First Name:   Last Name:

Street Address: 
Address Line 2: 
City:    State/Province:    Zip Code: 

Home Phone:      Other Contact Phone:    
E-Mail Address: 

Your Experience with Pets

How many pets do you currently own?        Dogs        Cats     Other
Are your dogs and/or cats spayed or neutered?  Yes No Some  
Who is your veterinarian?      City/State: 
Have you owned pets in the past that you no longer have and are still alive?   Yes No Some
    How did you obtain these animals? 
    Where are these animals now?  

After You Adopt Your New Pet

Why do you want to adopt a new pet?
   

Do you intend to keep your pet inside?  Yes No Some    Do you have a fenced yard?  Yes No Some
     If not inside, where will the pet be kept? 

# of adults in the home:       # of children in the home:       Their ages: 
How many consecutive hours would your pet be left alone on a typical day? 

Do you own the home?  Yes No Some
     If not, please list landlord's name, address, and phone number:
     Landlord Name:               
     Landlord Address:            
     Landlord City/State/Zip:  
     Landlord Phone:               

Other Information

Is there a specific pet you saw on the website that you're interested in?   

Any other comments or questions for us?