Adoption Application Form INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. MAKE SURE YOU ANSWER ALL QUESTIONS AND SIGN APPLICATION. Name* First Last Spouses Name First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Work PhoneAge*Email* Driver’s LicenseName of pet you are applying for*Do you want this pet for*CompanionProtectionGiftThis pet will be without human contact for about?*How many hours per day and days a week?Where do you live?* House Apartment Rent Own With Parents Landlord’s NameLandlord’s PhoneDo you have a fenced yard?*NoYesHeight and type of fencePlease provide the following information about your householdNumber of adults*Ages of adults*Number of children*Ages of childrenWould you be willing to allow us to visit your home before the adoption is completed?*YesNoHave you ever given up a pet? When/Why?*Have you ever adopted an animal before? Where from?*What types of pets do you own or have owned in the last 5 years?NameType/BreedKept WhereAgeNeuteredSexStill Own? Who is/was your veterinarian for the above animals?Provide Name and Phone NumberDo we have your permission for your veterinarian to release medical records to us?* Yes No Please provide a personal referenceProvide Name and Phone NumberSignature*By signing this application I give my full consent to Sanilac County Human Society to receive all information from my veterinarian that they have on file about all of my animals. PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.