Adoption Application FormINCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. MAKE SURE YOU ANSWER ALL QUESTIONS AND SIGN APPLICATION. Name* First Last Spouse's 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 LicenseWhat type of pet are you applying for?*DogPuppyCatKittenName of pet at shelter you are interested in?For what purpose are you looking to add a pet to your family?*CompanionProtectionGiftThis pet will be without human contact for about?*How many hours per day and days a week?Housing - Own or Rent* Own Home Rent House Apartment Condo Mobile Home Complex With ParentsIf renting or in an apartment, condo or mobile home, please provide the name of the complex.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 living at your residence*Ages of children living with youDo you have children that visit you?*YesNoAges of children who visit youWould 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 NoPlease provide a personal referenceProvide Name and Phone NumberBy signing below, I certify that the information I have given is true and that I recognize that any misrepresentations of the facts may result in my losing privilege of adopting a pet from the Sanilac County Humane Society. I authorize investigation of all statements on this application.Signature*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.