Adoption Application

To be considered for an adoption today, you must: *Be at least 18 years old *Have landlord's consent to own an animal at the address below *Have verifiable identification *Understand that Winnebago County Animal Services has the right to deny your application So that we may be assured the animal you wish to adopt will be best suited to you, your home, and lifestyle, and be placed in an environment most compatible with its needs, please provide us with the following information by completing the entire form. *We welcome adopters who rent or live in an apartment or condo. We want to alert you that some landlords and management companies have size and breed restrictions, limits on number of pets, and/or require a pet deposit or additional fees.

Date(*)

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Animal Type(*)

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Animal ID No.

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Last Name(*)

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First Name(*)

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Address(*)

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City(*)

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State(*)

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Zip Code

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How Long Have You Lived At This Address?(*)

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Email Address

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Home Phone Number(*)

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Cell Phone Number

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Landlords Name-If Applicable

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Landlords Phone Number

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What Was Your Previous Address

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Number Of Adults Living in This Household(*)

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Number of Children in Household

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Children Age Range

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If For Some Reason You Are Unable to Keep Your Pet You Understand You Must Notify Animal Services(*)

YesNoInvalid Input

How Many Cats In Home

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How Many Dogs In Home(*)

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Please provide the name of each animal listed above

Pet Name

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Type or Breed

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Inside or Outside Pet

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Age

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Spayed or Neutered

YesNoInvalid Input

Gender

MaleFemaleInvalid Input

Still own

YesNoInvalid Input

Are you familiar with the pet responsibility laws in your area(*)

YesNoInvalid Input

Why are you interested in adopting this animal

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Does Your Pet Have a Current Rabies Shot

Yes NoInvalid Input

If So What County

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Are you familiar with the needs of this specific Breed(*)

YesNoInvalid Input

Where will the animal be kept during the day(*)

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Where will the animal be kept during the night(*)

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Your new pet may take a month or longer to adjust to its new home especially if you own other pets are you willing to allow for this adjustment(*)

YesNoInvalid Input

Animals often live longer than 15 years and you can expect to spend several hundred dollars a year to feed vaccinate license and provide medical care for your animal are you read to be responsible for this animal its entire life(*)

YesNoInvalid Input

What is the name of your veterinarian or veterinary clinic

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How Did You Hear About Us(*)

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Please Share your experience in our adoption rooms

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By signing below, I certify the information I have given is true, I am at least 18 years old, and that I understand any misrepresentation of facts may result in losing my privilege of adopting a pet through Winnebago County Animal Services. I also understand that Winnebago County Animal Services has the right to deny my request to adopt an animal, and I authorize investigation of all statements in this application

Digital Signature(*)

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OFFICE USE ONLY Date:________________ Staff Member:______________________ ___Approved ___Denied Reason Denied:________________________ ________________________ Verifiable Identification:____________ Animal ID Number: A____________ Comments:___________________________________________________________________________________________________

After your application has been reviewed by our staff, it will either be approved or denied in conjunction with our approval guidelines. If you are approved you will receive a Pre-Approved Adoption E-Ticket to your email. Please make sure you print this E-Ticket off and bring it with you to the shelter when you visit. Please make sure to check your junk email/spam folder as well. Thank You.

Adoption Application

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