Adoption Application Leave this field blank Name of Animal We process applications once you have found a specific animal you are interested. We keep them on file for 30 days First Name Last Name Phone Number Alt. Number Email to keep information up to date on mypethealth.com Address City State Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip code Number of kids in the home Ages Are they experienced around animals? Are you 18 years or older Full names of all adults in the home Do you live in a HouseApartmentCondoMobile Home Allergies Is anyone in the household allergic to animals? If yes, explain. Name of neighborhood, complex, trailer park Name of Landlord Landlord Phone number Employment status EmployedUnemployedStudentRetired Personal Reference #1-Name Please list 2 personal references including at least 1 non-family member (Please do not include anyone in the household) Personal Reference #1- phone number Personal Reference #2- Name Please list 2 personal references including at least 1 non-family member (Please do not include anyone in the household) Personal Reference #2- Phone Number Have you adopted from us before Will the pet be IndoorOutdoorBoth Have your current animals been around CatsBig dogsSmall dogs Have you surrendered an animal to a shelter before? If yes, please describe Current Animals Please list all the current pets in the home Name, species, breed, gender, spay/neuter status If you don't have any pets, please list your most recent if applicable Current Animals Continued Previous Pets Please list your most recent previous pets and what happened that they are no longer with you Veterinary Clinic If you do not have any animals, please put N/A Name on the account Whose name is your pet under at the vet Notes Please include any other information you think may help us match you with an animal. I understand that Adopting a pet is a long-term commitmentWe may perform a criminal background check, check with personal references, and/or check with vet references as a part of this processWe reserve the right to approve or deny any application in accordance with policies established by our Board of DirectorsWe reserve the right to find the best home possible for the animal as we see fitWe do not 'hold' animals, we work on *completed* applications on a first come, first served basisWe only adopt one animal/species at a time unless noted otherwise in order to allow proper adjustment timeMy current pets must be current on vaccines and spayed/neuteredThis is a shelter environment and my pets could potentially be exposed to viruses/illnesses during an interactionPlease read each statement and check the box once complete I certify that all information I have given in this application for a pet is true and correct to the best of my knowledge and belief. I give the Humane Society of Whitley County permission to contact the veterinarians and landlord I have listed for the purpose of verifying information. Sign and date in the box provided Submit