Application Form

Applicant Information

Name*:

Address*:

City*:

State*:

Zip*:

 

Age*:

Date of Birth

Driver's License*:

Phone Number*:

Email Address*:

Currently enrolled in college? YesNo

 

Current Employer*:

Full/Part Time: Full TimePart Time

If unemployed, what is your source of income?

 

How many adults live in your home?*

How many children live in your home?*

What are the ages of the children?

Does everyone in your household agree to adopt a new pet? YesNo

 

Housing Information

Do you own or rent? OwnRent

Do you have a fenced in yard? YesNo

Are you planning to move in the future? YesNo

If so, what are your plans for your pets?

Type of home: HouseDuplexApartmentMobile Home

How long have you lived at current residence?

Name of landlord/property manager:

Phone number of landlord/property manager:

 

What animal are you applying for?

Have you ever adopted from a shelter before? When and where?

Have you ever returned an animal to a shelter? YesNo

If so, why?

Have you ever surrendered a pet to a shelter? YesNo

If so, why?

What will be your method of training and discipline?

What behaviors, if any, would cause you to return the animal you are adopting to our shelter?

Are you in favor of spaying/neutering your pets? YesNo

If adopting a cat or kitten, are you in favor of declawing? YesNo

If so, why?

What is your reason for wanting to adopt this pet?*

Please list pets that you have owned in the past:

Why do you no longer own these pets?

Other pets currently living in the home:

Current Pet Information

First Pet's Name:

Breed:

Age:

Spayed/Neutered? YesNo

Indoor/Outdoor? IndoorOutdoor

 

Second Pet's Name:

Breed:

Age:

Spayed/Neutered? YesNo

Indoor/Outdoor? IndoorOutdoor

 

Third Pet's Name:

Breed:

Age:

Spayed/Neutered? YesNo

Indoor/Outdoor? IndoorOutdoor

 

Veterinarian's Name*:

Veterinarian's Phone*:

Please call your veterinarian's office and let them know that it is okay to speak with us about your past and current pets.

The welfare of the animal is our foremost concern. We do our best to match every animal we adopt to a household that will becomes its forever home. The Lawrence County Humane Society reserves the right to refuse an adoption to anyone. Incomplete applications will not be considered or processed.

By signing below, I/we are stating that the information I/we have provided in our application is true and correct.

 

Signature:

 

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Cat Application Form

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Hours

Monday- CLOSED to the public
Tuesday- 12:00pm- 4:30pm
Wednesday- 12:00pm- 4:30pm
Thursday- 12:00pm- 4:30pm
Friday- 12:00pm- 4:30pm
Saturday 12:00pm – 4:30pm
Sunday- CLOSED to the public

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