Adoption Application
Printable Application

The Wayne County Humane Society, Inc. Would like to thank you for considering one of our pets for adoption. The following information will help our staff place you with the right pet for life. Please take a few moments to fill out the following information to the best of your knowledge.
Submitting the application will not guarantee the availability of any animal.

Please provide the following contact information:

Full Name
Street Address
Address (cont.)
City
State
Zip/Postal Code
Work Phone
Home Phone
E-mail

Please tell us about your household:

1. Housing: 
If you RENT provide your landlords name and Phone number:

2. Your household consists of: 

3. The activity level in your home is:   

4. Time at home: 


Please Tell us about your pet history:

5. Pet Owner Experience: 

6. Current Pets in the Household:
(Please include their Name, Breed, Age, Gender, Whether or not spayed/neutered,
If you keep them inside/outside or both, and How long have you owned?)
ONE(1) Pet Per Line OR Separate with a ;


7. Please Tell Us About Your Past Pets:
(Please include their Name, Breed, How long had you owned them?, and what happened to them?)
ONE(1) Pet Per Line OR Separate with a ;


8. Veterinarian Name and  Phone Number:


Please tell us what type of pet you are looking for:

9. I am Interested in Adopting a: 

10. I Would Prefer That My New Pet Be:

Sex: 
Age: 
Size: 
Training Level: 
Coat: 
Housing: 
Activity Level: 
Color:     Breed:

11. Select an Action: 


By clicking on the submit button, you are agreeing to the following:

I understand that the Wayne County Humane Society has the right to question and refuse all adoptions. I give permission to make inquiries about any and all records and information as provided on the Adoption Application, this includes all current and previous veterinary records and information. I will not hold liable the Wayne County Humane Society, Inc. or any establishment mentioned, if my application is refused for any reason. If my application is accepted, I understand that the Adoption Contract I will be required to sign is a legal and binding document. By signing this I agree to uphold all requirements in this document, including applicable adoption fees. I also agree to relinquish the animal to the Society if I fail to comply with the requirements to the satisfaction of the Society.


[Wayne County Humane Society]. All rights reserved.