Adoption Form

Please complete the following information as thoroughly as possible and click the Submit button to send the information to us. Alternatively, you may download and fill out a printable version of this form and return it to us at your convenience. Thank you! We look forward to hearing from you.

Download Printable Application »

* indicates a required field

I want to find:

What kind of animal are you looking for? CatDogOther

List any animal(s) in our shelter you are specifically interested in here:

Contact Information:

Name: *

Address:

City:

State:

Zip:

Home Phone (##########):*

Work Phone:

Email: *

Please answer all of the following questions:

1. Will you spay or neuter your pet?

2. Age

3. How long have you lived at this address?

4. Do you own?

5. Do you rent?

6. Landlord's Name

7. Landlord's phone number

8. Number of other adults in household

9. Ages of children living in household

10. Any household resident planning to move in next 1 - 2 years? YesNo

11. Household's source of income

12. Employer

13. Does anyone in your household have allergies? To What?

14. Do you have any other pets at home now? What?

15. Who is/was your veterinarian?

16. In what city is your vet located?

17. If you have pets now, are they spayed or neutered? YesNo

18. If you have pets now, when did they last see a vet? Why?

19. Have you had any other pets? What kinds?

20. What happened to them?

21. Who will be primarily responsible for pet care (grooming,training, etc)

22. Your pet will live:

If other, please specify:

23. Your pet will sleep:

If other, please specify:

24. In your usual week, what is the longest time your pet will be alone?

25. Where will the pet be kept when it is home alone?

26. Briefly, how would you deal with the following, if they became a problem:

Housebreaking (for a dog)/ not finding a litterbox (for a cat)

Keeping the dog/cat in the yard

Too much barking (for a dog)/scratching for a cat

Play-biting

Destructiveness

Aggressiveness

27. If a vet diagnosed a condition that would cost over $150 to treat, what would you do?

28. What circumstances would cause you to give up a pet?

29. How did you hear about our shelter?

By checking the box below you are certifying to the truth of your answers. If any of your answers prove to be untrue the adoption will not proceed. If you have taken the adopted pet home, the adoption will be voided and on notice to you, the pet will be returned to the Cedar Bend Human Society.

I certify that all my answers are true*

Date (MM/DD/YYYY)*:

In This Section

Get in Touch

Location

1166 West Airline Highway
Waterloo, IA 50703-9634

Phone
319-232-6887

Adoption Center Hours
Open Tues. - Sun., 10am - 5pm
Closed on Mondays

Phone
319-232-6887

Intake Center Hours
Open seven days a week,
8am - 5pm

Phone
319-232-6887

Animal Control Hours
Open Mon. - Fri., 8am - 5pm

Phone
319-235-5335