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:

Be at least 21 years of age.
Have the knowledge and consent of all adults living in your household.
Have a valid ID with current address.
Understand that completing this application does not guarantee adoption and that the Humane Society of Central Illinois must approve your application.

Details

Which Animal are you interested in? - Required

Name of the Adopter - Required

First Name Middle Last Name

Adopter's Email - Required

Co-Adopter(s)

Street - Required

City - Required

State - Required

Zip Code - Required

County

Primary Phone - Required

Alternate Phone

Do you:

Attend School
Work

Employer

Spouse/Partner's Employer

Do you live in a: - Required

Do you: - Required

Rent
Own
Live with Parents

Landlord's Name

Landlord's Phone

How long at current address?

If less than one year, list your previous address and how long there

Provide the following information about your household:

Number of Adults - Required

Number of Children - Required

Ages of Children

Do the children live in the home fulltime?

Who will be primarily responsible for the care (feeding, grooming, exercise and training) of your new pet? - Required

How many pets do you have now?

Dogs - Required

Cats - Required

How many pets have you had in the last five years?

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.

Current or Past Pet #1

Current or Past Pet #2

Current or Past Pet #3

Current or Past Pet #4

Current or Past Pet #5

Have you ever adopted an animal from HSCI? - Required

Yes
No
If yes, when?

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. In the event of an adoption, I authorize the Humane Society of Central Illinois to share my email and information with Hill’s Science Diet and 24PetWatch. 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.

Signature - Required

Date - Required

Signature

Date