Pre-Adoption Application

Contact Information

First NameLast Name

Email Address

Phone Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState

Zip Code

Is there a specific pet that you are interested in adopting? If so, please name them below:

Are you 18 years of age or older?

Are you adopting this pet for yourself?

Do you realize that owning a pet has certain legal, moral and financial responsibilities?

Do you realize a cat or dog may live 15 or more years and may need veterinarian care that goes beyond yearly shots?

Are you familiar with the animal control regulations in your area?

Are you planning on moving in the near future?

Do you have children/frequent visitors under 12 years old?

If so, ages..

Are you wanting to adopt an animal for a...

In the last 2 years, have you lost any animal due to death, had any that ran away or had to give up animals? If so, what was the cause or reason? If not, please insert "NA".

Do you own any other pets at the present time? If so, please specify (name, species and breed). If not, please insert "NA".

Are your current pets up to date on their annual vaccinations? If no pets, please insert "NA".

Are they spayed or neutered? If no pets, please insert "NA".

Have you previously adopted from the Muscatine Humane Society?

If so, how long ago and do you still have that animal?

Do you have a veterinarian?

Veterinarian Name

First NameLast Name

Veterinarian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

If the vet records are not under the applicants name, please provide the correct name for the reference check below:

What do you live in?

Do you own or rent your home?

If renting, name and phone number of landlord is required, if not applicable please insert "NA":

Do you have a yard?

Do you wish to have your pet live indoors or outdoors?

If you answered "both" to the above question, how would you keep said pet confined to your property when outdoors?

Depending on the number of applicants for a specific animal, there may be a short period of time before we make a final decision to which home the animal will be placed. These decisions are based on what the animal's needs are and the desire to palce them in a permanent and happy home.
By clicking the submit button, I understand information will be checked including veterinary and personal.
Incomplete applications cannot be processed. Please make sure you have answered each question completely and honestly.
The Muscatine Humane Society reserves the right to deny any person the adoption of a pet.
By clicking the submit button, I verify all of the above information is true and accurate.

Date

Signature of Potential Pet Parent