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Science Channel posted an episode on Facebook: Your Brain On Puppies


Below is an application for adoption that I filled out online for a shelter.



Today's Date = April 19, 2018
Name of pet(s) applying for (List in order of preference) = Bella


Your Name =
Place of employment = Unemployed/Disabled
Drivers License =
Spouse (or significant other) name = N/A
Spouse place of employment = N/A
Drivers License =
Full names of all other adults in the home and relationship to you = I live alone.
Name and age of children (full and part-time) = N/A
Street Address =
City / State / Zip = Kendall, WI
Mailing Address (if different) =
Home Phone Number =
Alternate Phone #1 (list whose) =
Email address(es) =


A) Reason(s) for wanting a dog (for kids, hunt, herd, protection, obedience, farm help, etc) = Emotional Support Animal.
B) Home is: Owned by me, Leased/Rented, Owned by parents = Rented Apartment
C) Will this be an indoor or outdoor dog? = Indoor dog
D) When outside will dog be: in fenced yard (list type and height), loose/boundary-trained, leashed, kenneled (list size) = leashed under my total supervision.
E) Where will the dog be at night? = sleeping on my lap or in it's own bed if that is what it wants.
F) Where will the dog be when you're not home? = In a kennel if needed.
G) Will the dog be loose outside unattended? = Never
H) Describe exercise the pet will get = Going for long or short walks with me.
I) Why is this particular pet a good match for you? = Bella would be a perfect match for me as she is smaller for living in an apartment and will not need as much exercise as a larger dog would.


List the vet clinic(s)(and phone#) you'll use for this pet = Mauston Veterinary Clinic in Mauston, WI - 608-847-6049 or Esta's Mobile Veterinarian in Wilton, WI - 608-435-6649
If renting, you must bring written permission from your landlord or a copy of your rental agreement at the time of adoption.

Sadly this may be a problem bringing written permission from my landlord. I have been a very good tenant since 2009, long before the current landlord owned the building. He allowed me to have cats since I had them when he bought the place. I recently spoke to him about getting a dog. He said no. I am in the process of getting an Emotional Support Animal letter which then he cannot refuse me. I suppose though that you still even in this situation will still need written permission? :-/


Include for all cats and dogs in the format below:
Name / Breed / Age / Sex / neutered/spayed? / Yrs Owned / Where Acquired / Lives Indoors or Out
Pet 1 = Lucy/ domestic cat/ female/ spayed/ 1 year come May 10th 2018 I have owned her/ I got her from someone on Craigslist in Tomah, WI/ Lives indoors
Pet 2 =
Pet 3 =
Pet 4 =
Pet 5 =


Include all cats and dogs in the format below:
Name / Breed / Age / Sex / neutered/spayed? / Yrs Owned / What happened to pet / How long ago / Indoors or Out
Pet 1 = Annie/Domestic cat/ Female/ 10 years/ spayed/ 10 years owned/ She had many health problems and I had to put her down March 2nd, 2018/ Indoors
Pet 2 = Jazz/ Parakeet/ 11 years old/ Male/ Not spayed or neutered, Not Applicable/ 11 years owned/ Sadly he died on May 26, 2017/ Indoors
Pet 3 = Widget/ Domestic cat/ 6 years/ Male/ Unneutered/ 6 years owned/ I had to put him down July 5th, 2016/ Indoors
Pet 4 = Tasha/ Shepherd - Heeler mix/ 11 years old/ Female/ spayed/ 2 years owned/ I rehomed her to my ex husband in April of 2009 when I moved into this small apartment as she was better with him where he still lived in our house with a half acre fenced in yard in Beloit, WI. and he walks her twice a day - please ask if you'd like to know more/  Indoors and outdoors supervised on leash for walks.
NOTE: Add more lines if needed for Current and Previous Pets. Failure to mention any dog or cat will cost you the adoption!


Returns are hard on pets and the family, so help us prevent them. To ensure this is a great match for you and your lifestyle, please tell us what you require in this dog. Expect at least a 30 day "adjustment period" for any pet.
A) Must it be good with strangers? (Not shy / Not Protective) = yes
B) Must it be good with dogs? = n/a
C) Must it be good with cats? = yes
D) Must it be good with children? = n/a
E) Must it be able to be loose unattended outside? = No. All of my pets are always indoors.
F) Must it be potty trained within 30 days? = no
Have you carefully read our entire Adoption Process? = "We Care"
If approved, we require that you be able to pickup your new pet within one week. You must come during open hours. (Noon to 3 PM on Mon, Wed, Fri and Sat). Please pick a specific date =
We will email you (generally done in the evenings) to setup a time to meet and adopt the pet. If you're unable to check your email at night, let us know, otherwise please frequently check your email!
Please take a moment to be sure all questions were answered completely. As stated in the rules, mark "n/a" if a line does not apply. This is your one chance to impress us! The info you give us will make sure we're matching the right pet and right family together for a happy ending! Do you realize applications we feel are not complete cannot be processed? = yes

IMPORTANT! -- If we find a perfect home for a particular pet, we may cut off any further applications that have been started. You must sign/type your name below. In doing so, you are agreeing you've read our entire process and are swearing that all information you entered is correct. You also realize that by submitting your application, you are in no way guaranteed a pet. CCHS takes great pride in not just finding "a home", but a great home for each of our special pets. Rarely do we deny an applicant, so if you miss out on a pet, please do not think of yourself as being denied. With the pet's best interest in mind, as well as yours, we match people and pets together for long-term relationships and we'll try to help you find a great companion soon! CCHS has the right to deny any application, for any reason, at any time. =

Thank You For Considering One of our Special Pets!!


Pictures of my past emotional support animals click here.



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