Section 1
In order to be considered for an adoption today you must:
- Be 18 years of age
- Have the knowledge and consent of all adults living in your household
- Have verifiable identification
- Understand that the AMHS has the right to deny your application

So that we may be assured that the animal you want to adopt will be best suited for you, your home and lifestyle, we would like you to provide us with the following information. This form should take approximately 10-15 minutes to complete. Thank you for your cooperation.

NOTE:. In order to process this application, ALL fields that apply to you MUST be completed.

Applicant:   
>>This online form will only work if all of the following 8 * fields with are correctly entered<<
*Animal Interested in Adopting:
*Name:
*E-mail address:
*Street Address:  *Home Phone:
*City: *County: *State: *ZIP:
How long have you lived at the above address?
years
Previous address (if less than 5 years)
City County:
State: ZIP:
Work Phone#   Date of Birth:
Employer:  Occupation: How long?
years
Co-applicant (Spouse or Significant Other):      
First Name:

 Last Name:

Date of Birth?
Employer:

Occupation:

How long?:

 years

Please indicate where you live: apartment house condo/townhouse
trailer/mobile home

Do you... rent home own home

If you rent, do you have the landlord's permission to own a cat? Yes No
      Who is the landlord?

   What is the landlord's phone number?

Other Family Members:  
How many people are currently living at this residence?
Men:
 number? ages?
Women:
 number? ages?
Girls
 number? ages?
Boys:
 number? ages?

Please tell us the names of the people in your household:
Are the people in your home experienced with cats? Yes No
Is everyone in the household agreeable to getting a new cat? Yes No
Do you plan on moving in the next 6 months?
Yes No 		Would your pet go with you if you moved?
Yes No
List animals you currently own or that are in your care/house and those you have owned in the past five years, if you need more room list in comment box below:
Dog
Cat
Other 		Name

If other, what:
 Breed: Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed: Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 		Breed: Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed: Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long Owned?
 Where is it
now?
Dog
Cat
Other 		Name

If other, what:
 Breed:
Male
Female 		Spay/Neuter
Yes
No 		Housed
Inside
Outside
Both 		How long
Owned?
 Where is it
now?
Additional comments about current pets or pets owned in the last five years:
Have you applied to adopt or adopted from our Shelter or other animal shelter before? yes no
If from another shelter, which one?
What veterinary hospital do you use (or do you plan to use)?
Are your current pets up-to-date with their vaccinations?

yes no      don't know
 ( I don't have pets yet)
Under whose name are the veterinarian hospital records?
Please list your veterinarian's phone number

Do you foresee any major changes in your life in the next 15-20 years (average lifespan of a cat) such as marriage, childbirth, health problems due to age, going away to college? Yes No  -  If yes, please explain:

Can you provide a permanent home for this cat for 15-20 years? Yes No

Who is going to be the main pet caregiver?
Do any family members have allergies? Yes No  
Do you plan to let your pet have babies? Yes No if yes, please tell us more:
Do you plan to spay/neuter your pet? Yes No If no, please tell us more 

Have you ever given a cat up because it didn't work out? Yes No
If so, please explain the circumstances and what happened to it:

It may take your new pet two weeks or longer to adjust to its new home. Are you prepared to allow for this adjustment period? Yes No
On an average day, how long will your cat be left without human companionship? hours
Are you familiar with the pet laws in your area? Yes No
What brand of food do you plan to feed?
What type of ID will your cat wear?
How do you plan on exercising your cat?
Do you plan to allow your cat outdoors?
If yes, under what circumstances		 Yes No
Do you know how to train your cat to Stay Off Furniture/Tables? Yes No
Do you know how to train your cat Not to Chew Plants? Yes No
Do you know how to train your cat Not to Scratch Furniture? Yes No
Cats can live longer than 15 years; are you ready to take responsibility for the cat’s entire life? Yes N o
Please enter any additional comments that you may have regarding this application:

For applicants outside of Polk County:
References, outside of your family:
  Name Phone Number
1
2
3

Please list your area shelters and their phone numbers
  Shelter Phone Number
1
2
3

The undersigned applicant hereby grants the Arnell Memorial Humane Society permission to confirm any information provided in this application with any appropriate third party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by the Arnell Memorial Humane Society for purposes of this adoption application.

I certify that all the information on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I also understand that this adoption application is the sole property of the Arnell Memorial Humane Society.

It is specifically understood that the Arnell Memorial Humane Society reserves the right to deny any adoption application at its own discretion.

Typing your name below will serve as legal signature.
By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue cat and possible removal of said cat from my home. Applicant must be 18 years of age or older. We reserve the right to refuse any applicant.
Date: Driver's license #:

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IF you have problems with this ONLINE form,
click HERE to print an adoption form
and
Snail Mail it to us at
Arnell Memorial Humane Society
P.O. Box 314
185 Griffin St. E.
Amery, WI 54001