Monroe County Humane Association
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Adoption Application

If you are interested in adopting an animal from the City of Bloomington Animal Shelter, please fill out the following form. After completing the form, you will be able to print a formatted copy, which must be either faxed or delivered to the City of Bloomington Animal Shelter for review and approval prior to the time of adoption. You may fax this completed form to (812) 349-3440. Please make sure to answer the questions as completely as possible in order to avoid delays in the adoption process. Required fields are indicated by a red asterisk.

* Name * Home Phone
* Address Work Phone
Apt. # * City
* State * ZIP
E-Mail
* Which animal are you interested in adopting?
Please enter the animal's name, ID #, breed, sex or a short description

How did you hear about the City of Bloomington Animal Shelter?

Why did you come to look at this particular companion animal? (Select all that apply)

Met at Shelter
TV Show Pets Without Partners
MCHA Website
Flyer posted in Bloomington
Friend/Family
Petfinder.com
* I / We live in a
House
Apartment
Condo
Duplex
Townhouse
Mobile Home
(Provide name of mobile home park)
* I / We
own our home
rent or live with a relative.
If you own a condo, please list the homeowner's association contact name and telephone number.
If you rent your home or live with relatives, please provide the property owner's name and telephone number.
* Total number of rooms in your residence:
* How many adults live in this residence?
List the ages of children in your home.
Child 1
Child 2
Child 3
Child 4
Child 5
* Who will have primary responsibility in caring for this animal?

* Why did you choose this particular companion animal?


* Within the last year, have you cared for companion animals you no longer have?

Yes
No
If yes, what happened to that companion?


* Have you ever adopted from the City of Bloomington Animal Shelter?
Yes
No
If yes, when?  

* Will this companion be kept
Exclusively inside
Exclusively outside
Both
If both, how many hours a day will they be outside?  
Will they be supervised?   Yes   No  

I / We will confine this companion animal by (Check all that apply)
A fenced yard
Runner
Leashed walks

Who is your current veterinarian?

In whose name are the records listed?


Please list all companion animals currently living in your home.
1. Species Age Name Spayed/Neutered?Y N
If not spayed/neutered, why?
 How long has this pet been in your care?
Indoors
Outdoors
Both
2. Species Age Name Spayed/Neutered?Y N
If not spayed/neutered, why?
 How long has this pet been in your care?
Indoors
Outdoors
Both
3. Species Age Name Spayed/Neutered?Y N
If not spayed/neutered, why?
 How long has this pet been in your care?
Indoors
Outdoors
Both
4. Species Age Name Spayed/Neutered?Y N
If not spayed/neutered, why?
 How long has this pet been in your care?
Indoors
Outdoors
Both
5. Species Age Name Spayed/Neutered?Y N
If not spayed/neutered, why?
 How long has this pet been in your care?
Indoors
Outdoors
Both
6. Species Age Name Spayed/Neutered?Y N
If not spayed/neutered, why?
 How long has this pet been in your care?
Indoors
Outdoors
Both
7. Species Age Name Spayed/Neutered?Y N
If not spayed/neutered, why?
 How long has this pet been in your care?
Indoors
Outdoors
Both
8. Species Age Name Spayed/Neutered?Y N
If not spayed/neutered, why?
 How long has this pet been in your care?
Indoors
Outdoors
Both

Note: This application is not binding and is not a guarantee of adoption. It is intended to facilitate finding the best fit for specific companion animals with appropriate homes. We reserve the right to verify any information contained in this application, contact property owners and perform yard and home inspections. We also reserve the right to refuse any adoption we determine not to be in the best interest of either the companion animal or the applicant.

I understand that
  • adopting a companion animal can be a 15-20 year committment.
  • I am responsible for assuming the expenses of providing annual veterinary care and vaccinations, spaying/neutering, quality food, emergency veterinary care, grooming and so forth.
  • companion animals, especially dogs, require training, and
  • if I cannot meet this companion animal's needs, I will return him/her to the City of Bloomington Animal Shelter.
MCHA   P.O. Box 1334 Bloomington, IN 47402-1334     (812) 333-MCHA