How to Adopt a Pet at the Eau Claire Pet Shelter | Eau Claire County Humane Association

Animal Information

* Do you have pets of your own? Yes No

Pets 1

Species:

Breed:

Sex:

Age:

Spayed/neutered:

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* Are your animal(s) up to date on vaccinations? Yes No

Distemper Rabies Bordetella FeLV/FIV (cats only)

Current Veterinary

Veterinary Name

Veterinary Phone

Veterinary Address

Where did you hear about our foster program?

Why would you like to join our foster program team?

Emergency Contact

Name

Phone

Agreement

The undersigned applicant hereby grants the Eau Claire County Humane Association permission to confirm any information provided in this application with any appropriate third-party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by the Eau Claire County Humane Association for purposes of this adoption application.

I certify that all the information on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I also understand that this adoption application is the sole property of the Eau Claire County Humane Association.

It is specifically understood that the Eau Claire County Humane Association reserves the right to deny any adoption application at its own discretion.

Typing your name below will serve as a legal signature.

By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of the rescue animal and possible removal of said animal from my home. Applicant must be 18 years of age or older. We reserve the right to refuse any applicant.

* Signature:

* Date:

Security Code

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Choosing a Companion

Costs of Pet Ownership

Foster Application

Small Animals:

Dogs:

Cats:

Personal Information

Animal Information

Pets 1

Current Veterinary

Emergency Contact

Agreement