Other Adoption Application

All pet adoptions require a completed adoption application. Complete the adoption application on this webpage and when finished filling in the fields, click the "Submit Application" button. Many fields on this form are required.

In order to be considered for an adoption you must:

  1. Be at least 20 years of age.
  2. Have the knowledge and consent of all adults living in your household.
  3. Have a valid ID with current address.
  4. Understand that completing this application does not guarantee adoption and that the Humane Society of Central Illinois must approve your application.

- Required

  First Name       Middle       Last Name

- Required

- Required
- Required
- Required
- Required

  • Attend School
  • Work

  • House
  • Apartment
  • Condo
  • Dorm
  • Mobile Home

  • Rent
  • Own
  • Live with Parents

Provide the following information about your household:

  • Yes
  • No

How many pets do you have now?

Please list any pets you now have or have had in the past. Include Name, Type/Breed, Age, Sex, is the pet fixed, and why you no longer have the pet. If more space is needed provide details to the Adoption Counselor.

  • Yes
  • No

By entering my name below (and spouse/partner if applicable), and clicking the 'Submit Application' button, I certify that the information given is true and correct and I recognize that any misrepresentation of facts will result in my losing the privilege of adopting a pet. I also give my veterinarian permission to release any vet care records and information about my current and past pets to the Humane Society of Central Illinois. I understand that this application is the property of the Humane Society of Central Illinois and that the Humane Society of Central Illinois has the right to deny my request to adopt. I authorize the Humane Society of Central Illinois to use my likeness in a photograph in any and all forms and media, including but not limited to publications, brochures, websites, exhibitions, digital media, social media such as Facebook, and any other printed or digital publications.