Adoption Application for a Small Animal

Adoption applicants must be 18 year of age or older. If you are under 18, please have your parent or guardian fill out this adoption form.

After filling out this form, click submit. An e-mail version of your application will be sent to the MHS.

Name (first, middle initial, last)
Maiden name
Date of birth
Day phone
Evening phone
Spouse or partner's name
Spouse or partner's maiden name
Spouse or partner's date of birth
Street address
City, State, Zip
Mail address (if different)
City, State, Zip
E-mail address
Do you?
 Own your house – or – Rent
If rent -- landlord's name:
Landlord's phone:
How long at current address?
If less than one year please show previous address:
[You're getting there.]
Are you:
If other, please specify:
Employer's name
Employer's phone
Spouse/partners employer's name
Spouse/partners employer's phone
What types of pets have you owned in the past five years?
PET 1 Name: Breed/type:
Age?
Sex?
 Female Male
Spayed/Neutered?
Yes No
Still own?
 Yes No
PET 2 Name: Breed/type:
Age?
Sex?
 Female Male
Spayed/Neutered?
Yes No
Still own?
 Yes No
PET 3 Name: Breed/type:
Age?
Sex?
Female Male
Spayed/Neutered?
Yes No
Still own?
Yes No
PET 4 Name: Breed/type:
Age?
Sex?
 Female Male
Spayed/Neutered?
Yes No
Still own?
 Yes No
Who has been your veterinarian?

If interested in adopting a SMALL ANIMAL -- please check areas you would like to discuss with an adoption counselor: ( Check ALL that apply.)
What to feed your pet and how often
Introducing your new pet to other pets
 Introducing your new pet to children and other family members
Where to keep your pet during the day, at night, or when you're not home
Care for your pet when you're on vacation or business trips
Bad habits
Litter box training or house training
Exercising
What to do if you have to move
Other (please specify):

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Please list two personal references:

Reference #1
Name Phone
Address, city, state
Reference #2
Name Phone
Address, city, state

By click "yes" you agree to the following statement:

"I certify that the information I have given is true, and I
authorize the MHS to contact veterinarians, landlords
and references to investigate all statements in this application,
and to do follow-up property checks."


Before submitting your application, please scroll up to make
sure you filled in all the fields above. When you are sure proceed. Note: your application is being submitted using a secure process to ensure confidentialty.


  (Click only once...this may take up to 15 seconds.)