Submit an application to adopt a pet

Owned From (Year)

Owned To (Year)

Current Status of Pet

All potential adopters must complete the following application. Complete and accurate information helps staff process your application more quickly. When you have finished completing the application, click SUBMIT.

Once we have processed your application, we will call you to let you know you have been approved.

Once your application is approved, our staff and volunteers are available to help you find the pet that best suits you and your lifestyle. Our goal is the happiness and well-being of both you and your adopted animal!

Information about Your Home and Family

Please include your area code on all telephone numbers.

Applicant Contact Information
Date of Birth:
Home Phone:
Cell or Work Phone:
Email:

Spouse / Partner Contact Information Name:
Date of Birth:
Home Phone:
Cell or Work Phone:
Email:

Street Address: Street:
City:
State:
Zip:

Mailing Address (if Different): Address:
City:
State:
Zip:

Household Information Own or rent your home?
How long at current address?
If Renting, what is your Landlord's Name?
Landlord's Phone:
# of Adults in Home:
# of Children in Home:
Ages of the Children (if applicable):

Pet Ownership Plans Please specify the type of animal you wish to adopt:
Who will hold primary responsibility for the care of your new pet?
Are you ready & willing to make a lifelong commitment to care for your pet?
If your pet presents adjustment problems (accidents, destructive behaviors, etc.) what will you do?
How many hours per day will your pet be alone?
When your pet is alone, will he/she be primarily indoors or outdoors?
If outdoors, please select the environment you envision:
Which statement best describes your motivation to adopt an animal?
Please tell us why you believe you would be a good pet owner?

Pet History Current Vet:

If your vet is not listed in the above choices, please enter your vet's contact information below:

Vet's Name:
City/State:
Phone:

Tell us about the dogs and cats you have owned during the course of the past 5 years:

Certification

By checking this box, I certify that the information I have given is true. I understand that WCHS has the right to delay or deny my request to adopt an animal. I authorize WCHS to contact my veterinarian and landlord (if applicable), and to investigate all statements in this application.

Date: ,