Adoption Questionnaire Please use the following form to inquire about an adoption at Willamette Humane Society. Pet InformationAre you interested in adopting dogs or cats from WHS?* Dogs Cats Do you have a specific adoptable pet in mind?YesNoAdoptable Pet Name*The name of the pet you're interested in adopting. Visible from the adoptable pets page.Adoptable Pet ID Number*The ID number of the pet you'd like to adopt. Visible from their adoptable pets profile.Have you ever adopted from WHS?*YesNoHow did you hear about us?*Statesman Journal NewspaperStatesman Journal WebsiteFacebookInternet SearchI've adopted beforeI've always known about WHSWHS Thrift StoreCraigslistDigital BillboardA FriendAn Outreach EventOtherOther Way You Heard About Us*Contact InformationName* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* Date Format: MM slash DD slash YYYY Phone*Email* Would you like us to call or e-mail you about this application?*Please call mePlease e-mail MeNeither, I'll come to WHSNeither, I'm just "window-adopting" for when the right pet comes along.Living CircumstancesType of Residence*HouseApartmentFarmOtherNumber of People in Household*Please enter a number from 1 to 25.Age Groups of People in Household Under 18* No children under 18 Expecting/baby on the way Infant Toddler Preschool Elementary School Middle School High School How many animal(s) are at your home?01234+Please describe the animal(s) currently are at your home, currently own or have owned in the last 5 years.Your Pet 1Type of Pet 1DogCatHorseBirdReptileRodentFishOtherIs Pet 1 Spayed or Neutered?YesNoNot SureGender of Pet 1MaleFemaleNot SureAge of Pet 1Please enter a number from 0 to 30.Is Pet 1 Indoor or Outdoor?IndoorOutdoorBothIs Pet 1 Current on Vaccinations? Yes No Not Sure Do you still have Pet 1? Yes No Why don't you have Pet 1?Your Pet 2Type of Pet 2DogCatHorseBirdReptileRodentFishOtherIs Pet 2 Spayed or Neutered?YesNoNot SureGender of Pet 2MaleFemaleNot SureAge of Pet 2Please enter a number from 0 to 30.Is Pet 2 Indoor or Outdoor?IndoorOutdoorBothIs Pet 3 Indoor or Outdoor?IndoorOutdoorBothDo you still have Pet 2? Yes No Why don't you have Pet 2?Is Pet 2 Current on Vaccinations? Yes No Not Sure Your Pet 3Type of Pet 3DogCatHorseBirdReptileRodentFishOtherIs Pet 3 Spayed or Neutered?YesNoNot SureGender of Pet 3MaleFemaleNot SureAge of Pet 3Please enter a number from 0 to 30.Is Pet 3 Current on Vaccinations? Yes No Not Sure Do you still have Pet 3? Yes No Why don't you have Pet 3?My Future Dog's NeedsMy dog will be primarily*IndoorsOutdoorsThe type of confinement I will have for my dog is*Hours per day my dog will be outside*Please enter a number from 0 to 24.I want a guard dog*YesNoI want a dog to herd or hunt with*YesNoWhen I'm not home, my dog will be* In a crate In the yard On a cable run In a kennel Crate training In the garage Loose in the house With a friend Professionally boarded Other My dog needs to get along with* Children Dogs Cats Other Animals None of the Above My Future Cat's NeedsMy household is*Calm / QuietAverageActive / NoisyMy cat will be*Select one or both. Indoors Outdoors My cat's litter box will be located*My cat needs to get along with* Children Dogs Cats Other Animals None of the Above We plan to declaw our cat(s)YesNoNot SureTerms & ConditionsI certify the information I have provided is true and understand that any false information will nullify the adoption agreement. Upon possible request, I agree to a pre and/or post adoption home inspection by an employee of Willamette Humane Society. I understand that WHS reserves the right to refuse any adoption at their discretion. I agree to the adoption application terms and conditions.* Yes Other comments or requestsWould you like to join our e-mail list?*Our monthly newsletter, Momentary Paws, has the most up to date information about adoptable pets, upcoming events, and exciting news!YesNoJoin Our Mailing List![Email_Signup_Short] EmailThis field is for validation purposes and should be left unchanged.