Auglaize County Humane Society Adoption Application

About You
Salutation:      First Name:   Last Name:

Street Address: 
Address Line 2: 
City:    State/Province:    Zip Code: 

Home Phone:      Other Contact Phone:    
E-Mail Address: 
Your Experience with Pets How many pets do you currently own?        Dogs        Cats     Other
Are your dogs and/or cats spayed or neutered?   
Who is your veterinarian?      City/State: 
Have you owned pets in the past that you no longer have and are still alive?  
    How did you obtain these animals? 
    Where are these animals now?  
After You Adopt Your New Pet Why do you want to adopt a new pet?

Do you intend to keep your pet inside?     Do you have a fenced yard? 
     If not inside, where will the pet be kept? 

# of adults in the home:       # of children in the home:       Their ages: 
How many consecutive hours would your pet be left alone on a typical day? 

Do you own the home? 
     If not, please list landlord's name, address, and phone number:
     Landlord Name:               

     Landlord Address:            
     Landlord City/State/Zip:  
     Landlord Phone:               
Other Information Is there a specific pet you saw on the website that you're interested in?   

Any other comments or questions for us?



Auglaize County Humane Society - 616 N. Dixie Hwy - Wapakoneta, OH  45895    (419) 738-7808