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HUMANE SOCIETY OF BURNETT COUNTY INC.
7347 Midtown Road
Siren, WI 54872
715-866-4096



Name

Address

City

State

Zip

Phone

dob

E-mail address?

Which pet(s) are you interested in adopting?

Number of children

Ages

Number of pets and type

How are these pets housed
Fenced yard

kennel with fenced run

chained or tied out

Your housing, do you
Own home

rent

room with others

Landlord and/or roomates name and phone number

Type of shelter you will provide for pet
day

night

Is someone home all day

Will the pet be crated?

If so for what reason

For how long

Who will care for the pet if you are gone for more than 12 hours

Have you previously own dogs or cats

If yes breeds and what happened to them

Veterinarians Name

complete address

phone



ALL QUESTIONS MUST BE ANSWERED
THE CARE PROVIDED FOR THE ANIMAL ADOPTED FROM HSBC MUST MEET OR EXCEED THE STANDARDS SET FORTH IN THE WISCONSIN STATUES OR THOSE OF THE STATE THE ANIMAL WILL RESIDE IN. FAILURE TO COMPLY WITH THESE STANDARDS WILL VOID ANY CLAIM YOU HAVE TO THE ANIMAL AND THE ANIMAL WILL BE RECLAIMED BY HSBC WITHOUT LEGAL RECOURSE BY THE ADOPTER.

Your veterinarian, landlord/room mates will be contacted prior to approval for adoption.