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 questionnaire
OFFICE USE ONLY
Date:________________ Staff Member:______________________
___Approved ___Denied
Reason Denied:________________________
________________________
Verifiable Identification:____________
Animal ID Number: A____________
Comments:___________________________________________________________________________________________________
After your questionnaire has been reviewed by our staff, it will either be approved or denied in conjunction with our approval guidelines. A representative will contact you to let you know if you are approved, denied, or if we need more information. Thank You.
