Survey - Adoption Profile - Wisconsin Humane Society

Thank you for choosing the Wisconsin Humane Society to help you find a shelter animal to join your family! We are committed to finding lifelong companions for our clients and placing animals into loving homes. Therefore, we ask each client to provide us with the following information. If you have completed a profile online in the past 60 days, you may skip this step. Thank you!

Contact Information:

Please fill in all information:

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Name:

First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number: Required

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Date of Birth: Required

Date of Birth:

Yes, I would like to receive e-mail from The Wisconsin Humane Society

Yes, I would like to receive postal mail from The Wisconsin Humane Society

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Question - Required - Government ID (drivers license number, state ID number, military ID, etc.):

If you adopt today, your contact information above will be uploaded to your dog or cat’s microchip. If they ever get lost and the finder is unable to reach you, who should be contacted next?

Question - Not Required - Secondary Contact Name:

Question - Not Required - Secondary Contact Phone:

Question - Not Required - Secondary Contact Email:

Housing Information

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Question - Required - Number of adults in home:

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Question - Required - Number of children in home:

Question - Not Required - Ages of children:

Please note: Some communities have restrictions on the type or number of animals permitted. Let your adoption counselor know if you would like help gathering this information.

Animal History

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Question - Required - Please list all animals in your home, including their name, species, age and whether or not they are spayed/neutered:

(Maximum response 255 chars, approx. 5 rows of text)

Terms & Conditions

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Question - Required - I would like to receive free pet food and other giveaways as part of my adoption. I understand that by accepting these gifts, I will receive future communications from WHS and its partners.

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Question - Required - In consideration of the Wisconsin Humane Society (WHS) allowing my interaction with animals, I agree to release and hold harmless WHS from and against any and all loss, damage, claims, liability, costs, and expenses of any nature whatsoever, including without limitation attorney's fees and disbursements, arising from or occasioned by my interactions with animals. I understand if an accident, injury, or illness should occur, no matter how minor, that I will notify a WHS staff member and seek any necessary medical attention utilizing my own medical insurance. I understand there are certain risks inherent in handling animals and I accept those risks.

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