Pre-Adoption Application
Muscatine Humane Society
Contact Information
*
First Name
Last Name
Email Address
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State
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?
*
Yes
No
Are you adopting this pet for yourself?
*
Yes
No
Do you realize that owning a pet has certain legal, moral and financial responsibilities?
*
Yes
No
Do you realize a cat or dog may live 15 or more years and may need veterinarian care that goes beyond yearly shots?
*
Yes
No
Are you familiar with the animal control regulations in your area?
*
Yes
No
Are you planning on moving in the near future?
*
Yes
No
Do you have children/frequent visitors under 12 years old?
*
Yes
No
If so, ages..
Are you wanting to adopt an animal for a...
Pet & Companion
Mouser
Guard dog
Hunter
Other
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?
Yes
No
If so, how long ago and do you still have that animal?
Do you have a veterinarian?
*
Yes
No
Veterinarian Name
*
First Name
Last Name
Veterinarian Phone Number
Please enter a valid phone number.
What do you live in?
*
Please Select
House (if you aren't listed on the deed, then deed holder name/number must be listed)
Apartment
Condo
Mobile Home
Farm
Do you own or rent your home?
*
Own
Rent
If renting, name and phone number of landlord is required, if not applicable please insert "NA":
*
Do you have a yard?
*
Yes
No
Do you wish to have your pet live indoors or outdoors?
*
Indoors
Outdoors
Both
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
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Month
-
Day
Year
Date
Signature of Potential Pet Parent
Submit
Submit
Should be Empty: