Star of the North Humane Society
Grand Rapids, MN
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PETS FOR ADOPTION
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Star of the North Humane Society
ADOPTION
APPLICATION
Name of Animal You Would Like to Adopt
*
Date
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Name
*
First
Last
Email
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Cell Phone Number
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-
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Home Phone Number
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-
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Are you 18 years of age or older?
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Yes
No
Choose One
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I own my own house.
I rent a house.
I rent an apartment.
Other...please explain below.
Other....
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If you RENT, please provide your landlord's name and number.
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Phone Number
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-
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Are there children in your home?
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Yes
No
If YES, please list their ages.
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Do you or any members of your household have allergies to animals?
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Yes
No
Employer
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Address
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City/St/Zip Code
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Work Hours
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Work Phone Number
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-
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May we contact you at work?
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Yes
No
WHAT KIND OF PET ARE YOU INTERESTED IN?
CHOOSE
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DOG
PUPPY
MATURE SIZE OF DOG
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LARGE > 50 lbs
MEDIUM 20 - 50 lbs
SMALL < 20 lbs
TOY
CHOOSE
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CAT
KITTEN
CHOOSE
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HORSE
OTHER....
Please explain OTHER:
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Please tell us about other specific requirements: breed, long hair, short hair, temperament, etc.
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CURRENT PETS
Please list the names, breeds, genders, and ages of your current pets:
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Please list the names, breeds, genders, and ages of some of your past pets.
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Are/were all of your cats/dogs spayed or neutered?
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Yes
No
If not, please explain:
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Are all your animals up-to-date on their vaccinations?
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Yes
No
If not, please explain:
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Have you ever adopted from a shelter or other rescue group?
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Yes
No
If yes, what is the name of that organization?
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CARING FOR YOUR NEW PET
Who will be the main caregiver(s) for your pet?
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Will the pet be housed indoors?
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Yes
No
Please describe the area where the pet will live:
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Where will your pet sleep at night?
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How many hours per day will your pet have human companionship?
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How long will your pet be left home alone each day?
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Where will your pet be kept while you are gone?
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Do you travel for business or vacation?
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Yes
No
If YES, who will provide care for your pet?
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Have you considered the daily expenses for maintaining a pet? (Food, medical, shelter, grooming, etc.)
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Yes
No
FOR DOG ADOPTIONS ONLY:
Do you have a fenced yard?
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Yes
No
If YES, height?
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How will your dog be exercised and how often?
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Have you had experience house training a puppy?
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Yes
No
If a behavior problem arises, are you prepared to contact Star of the North for training advice and resources and to invest the time needed to correct the problem?
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Yes
No
Anything else you would like us to know:
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VETERINARIAN
If you have a veterinarian please give his name and phone number.
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Phone Number
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-
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REFERENCES
Please list a reference who is not family member.
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First
Last
Phone Number
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Relationship to You
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Please list a second reference who is not a family member.
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First
Last
Phone Number
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-
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Relationship to You
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I give my permission for Star of the North humane Society to verify any of the information given.
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Yes
No
I certify that the information I have provided is true and I understand that any false information may nullify the adoption. I further understand that Star of the North Humane Society reserves the right to refuse any adoption they do not feel is appropriate.
Signature
*
If filling out online, please type in your name above.
Submit
