Dog Adoption Form

At the Humane Society of North Iowa, we seek responsible homes for our animals, where owners fulfill the physical, veterinary and emotional needs of their pets. Pet ownership is a very important commitment and it is our goal to ensure all pet adoptions will be a permanent placement for every animal.

Adopters must be at least 18 years old. All adults in the household must participate in this application and selection process. We may require a valid form of identification bearing the applicant’s current address. Renters must supply their landowner’s name and phone number. Veterinary care and housing arrangements for applicants’ current pets must meet HSNI standards.

By signing this application, the applicant gives express permission for the HSNI to investigate all statements made on this application. Specifically, the applicant gives the HSNI permission to inquire of and obtain veterinary care records for the applicant’s current or past pets. Also, for applicants who rent their dwelling, the Humane Society will contact the current landowner to confirm permission for applicant to house an indoor pet on the property. The Humane Society of North Iowa reserves the right to refuse any adoption application.

Dog Adoption Form

  • List the name of the dog you are interested in adopting. List additional names if you are interested in meeting multiple dogs. Type "unsure" if you haven't selected a specific dog.
  • Household Information

  • Some dogs are already housebroken, but may still have accidents as they adjust to a new home.
  • Pet Name:Type/Breed:Age:Spayed/Neutered:(Yes or No)Still own? (Yes or No, if no:why not?) 
  • By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of facts may result in my losing the privilege of adopting or keeping an adopted pet. I understand that the Humane Society of North Iowa has the right to deny my request to adopt an animal, and I authorize investigation of all statements in this application. I understand that this application is the property of the Humane Society of North Iowa.

  • We often receive multiple applications for the same animal. If your application is not approved, it does not mean you would be a bad home or owner. We have concluded that another home would better fit the animal's needs.

  • MM slash DD slash YYYY

Thank you for submitting your Adoption Application. Our Shelter Management staff will review your application and be in touch with you soon.  In the meantime, if you have any questions or would like additional information, please don’t hesitate to call us during our open hours: Tues-Fri (10-5), Wed (10-7) and Sat (10-4)

Our phone number is: 641-423-6241
Thank you!