Adoption Application

We are happy you are considering adopting one of our wonderful pets. The goal of our adoption program is to find permanent, loving, responsible homes for the animals in our care. We try to find a match that considers not only the best interests of the animal, but those of the caretaker as well. Understand that we have the right to deny any application.

Marion County Humane Society

1701 E Pleasant P.O. Box 655 Knoxville, IOWA

Name of pet you are interested in

First & Last Name*

Address - Include City, State, Zipcode*

Birthday - Must be 18 years or older when signed to be able to adopt*

Month

Day

Year

Phone Number*

Employer

Occupation

Email - Required if the animal you are adopting is microchipped (All of our dogs are microchipped)

I want this pet for (Mark all that apply)*

Companion

Outdoor only

Protection/Guard Dog

Family Pet

Companion for another pet

It can exceed $400 per year to care for a pet. Can you meet this responsibility?*

Yes

I live in a (Mark what applies)*

House

Apartment

Mobile Home

Farm

Dorm

Condo

Mark One*

I Rent

I own my home

I live with my parents

I rent to own

If you rent or live with parents please list their name and phone number please! If neither write NA*

Ages of Men, Women, and Children in the household please list below.*

Is anyone in your home allergic to animals? Dogs or cats?*

Yes

Please list all dogs & cats that you have had in the past 5 years, deceased or alive. Write down names, cat / dog, age, spayed or neutered, Up to date on vaccinations, if you still have them, if not please describe why. And where these animals were kept.*