Personal Information

Name of animal you would like to adopt.




Cell Phone Number

Home Phone Number

Are you 18 years of age or older?

Please choose one:

If you chose Other above, please enter your explanation here

If you RENT, please provide your landlord's name and number.
Landlord Name

Landlord Phone Number

Are there children in your home?

If YES, please list their ages.

Do you or any members of your household have allergies to animals? If yes, how will this be handled?


Employer address

Work Phone Number

What kind of pet are you hoping to find?

Please tell us about other specific requirements: breed, long hair, short hair, temperament, etc.

Please list the names, breeds, genders, and ages of your current pets:

Please list the names, breeds, genders, and ages of some of your past pets.

Are all of your pets up-to-date on their vaccinations and spayed/neutered?

If not, please explain:

If you have adopted from a shelter or rescue group before, what is the name of that organization?

Who will be the main caregiver(s) for your pet?

Will the pet be housed indoors? Please describe the area where the pet will live:

Where will your pet sleep at night?

How many hours per day will your pet have human companionship? How many hours per day will your pet be left alone?

Where will your pet be kept while you are gone at work, shopping, etc?

If you need to be away from home for more than the day, who will provide care for your pet?

Have you considered the daily expenses for maintaining a pet? (Food, medical, shelter, grooming, etc.)

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?

For Dogs

This section is required only for those requesting to adopt a dog/puppy.

Do you have a fenced yard? If YES, height?

How will your dog be exercised and how often?

Have you had experience house training a puppy?


If you have a veterinarian please give his/her name and phone number.




List a reference who is not a family member.


Relationship to you

List a second reference who is not a family member.


Relationship to you

Anything else you would like to include with your application:

I give my permission for Star of the North humane Society to verify any of the information given. 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 your name below)