Form Center

Basic Information

Which pet are you interested in?*
How did you hear about this pet?
1. Facebook
2. Friend/Family
3. Newspaper
4. Petco
1. Walk In
2. Website - Hutchinsonanimalservices.com
3. Website - Adopt-a-Pet
4. Other
Your Name*
Address*
City*
State*
Zip*
Email*
Home Phone*
Alternate Phone
Have you ever applied with us before?*
1. Yes
2. No
Are you at least 18 years of age?*
1. Yes
2. No
Rent or Own?
1. Rent
2. Own
Landlord Name (put N/A if no Landlord)*
Landlord Phone number (put N/A if no Landlord)*
Do you have children? If yes please list children's ages. *
If no please put N/A
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Are you getting this pet for:*
1. Yourself
2. Friend/Relative
3. A Surprise Gift
If applicable, list the type and height of fence:
What is the reason you want to adopt a pet?*
How many dogs in the home?
How many cats in the home?
Where will your pet live?
Does anyone in your house have allergies?*
Does your pet need to get along with:*
1. Cats
2. Children
3. Dogs
4. Elderly
5. None of the above
What do you expect the yearly expense of owning this pet to be?*
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It may take your new pet several weeks to adjust to your home, sometimes longer if other pets are involved. Are you prepared to allow this much time to adjust?*
1. Yes
2. No
Are there any behaviors you are unwilling to work with?*
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I certify that the above information is true and correct to the best of my knowledge. I also acknowledge falsification of the above can result in my denied adoption of an animal or, if an animal has been adopted to me, the return of that animal to the Hutchinson Animal Shelter. I understand that all animals must be spayed or neutered before they are released from the shelter.
Digital Signature*
Date of Birth*
Date of Birth
For Office Use Only
Petpoint System Number
Approved (Yes or No)
Vet Verification (Canine)
City License Verification
Municipal Pit Bull Ban?
Landlord approval (Yes or No)
P/U Date
SX Date and Location

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