Adoption Application

Thank you for your interest in adopting an animal from the Brown County Humane Society (BCHS). In an effort to ensure the best possible placement for the animals in our care, we ask that you fill out the following application completely. All information will be kept confidential. The person signing this adoption application must be the intended owner of the animal, if the adoption is approved. Additionally, please note that you must be at least 18 years of age or older to adopt an animal from BCHS.

PERSONAL INFORMATION

Your Name*
Address*

HOUSEHOLD INFORMATION

Please provide homeowner information below.
If your name is not listed as owner of property, provide name and phone # for property owner:

CURRENT ANIMALS IN YOUR HOUSEHOLD

Type N/A if not applicable

MATCHMAKING INFORMATION

Are you looking for an indoor or outdoor pet?*
Type N/A if not adopting a dog.
Type N/A if not adopting a dog.
Type N/A if not adopting a dog or if you have a fence.

ADDITIONAL INFORMATION

By signing this application, I am stating that I have answered all questions completely and truthfully. In the event that BCHS (at any later time) discovers a falsehood, the adoption can be annulled, and the animal seized. By signing this application, I acknowledge that I have been informed that BCHS reserves the right to deny any application.

Date*

*** Office Use Only ***

Date