GCHS Application
Pet adoption information form
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Today's Date:
How did you hear about this animal/GCHS? 
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First Name:
Last Name
Name of Animal you are interested in?:
What interests you about this animal? Please be specific.:
Address:
City, State, Zip:
Phone number:
Housing situation:
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If renting, landlord's phone number:
How long have you lived at your current address?:
How many adults live in your home, include yourself?:
How many children currently live in your home? Include their ages.:
Does anyone in the home have allergies?:
How many other pets do you own?: List kinds and ages.:
Please list any and all CURRENT PETS & PETS YOU HAVE OWNED IN THE PAST. You MUST include the following information: Type, Breed, Age, Sex, Altered?, Still Own?, If no, why? If you have never owned a pet, put "n/a"
Are you financially able to provide the following? Adequate food and shelter, annual vaccinations, exams and monthly heartworm preventatives, additional vet care for unexpected illness/injury, flea prevention, grooming and/or obedience training, if necessary for the animal you wish to adopt?
Name and number of Current Veterinary Clinic:
May we contact your veterinarian?:
Please list 3 references with phone numbers and email addresses. For the fastest approval, please let your references know we will be calling.
Please list your full name and type it below as an electronic signature.
We will contact try to contact you within 2 business days.  If you have not seen the animal's current status on Facebook or have further questions call us at 608-723-6366, message on FB or email at gchslancasterwi@gmail.com
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