Currently enrolled in college? YesNo
Full/Part Time: Full TimePart Time
If unemployed, what is your source of income?
Which dog/puppy are you interested in adopting?*
Who will be the primary caretaker of the new pet*?
First Pet's Name:
Male or Female? MaleFemale
Second Pet's Name:
Third Pet's Name:
What other pets do you currently own?
Other pets currently living in the home that you don't own
Who's name are the records under?
Please call your veterinarian and give permission to release your records to the Lawrence County Humane Society.
Are you looking for an indoor or outdoor dog? IndoorOutdoor
Where will the dog/puppy be kept when no one is home?*
How many adults live in the household?*
How many children live in the household?*
Have you ever adopted an animal from an animal shelter before? YesNo
If yes, from where and how long ago?
Have you ever returned an animal to a shelter/rescue? YesNo
If yes, please explain:
Are you in favor of spaying/neutering your pet? YesNo
Are you aware that the new animal you may adopt has not been examined by a veterinarian while housed at our shelter? YesNo
Do you own or rent? OwnRent
How long have you lived at current residence?
Type of home: Single FamilyCondoTownhouseTrailer
Name of mobile home park, apartment complex, or condo complex:
Name of landlord/property manager:
Phone number of landlord/property manager:
What is your main reason for wanting to adopt the animal you are applying for today?