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
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
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
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:
First Pet's Name:
Breed:
Age:
Spayed/Neutered? YesNo
Indoor/Outdoor? IndoorOutdoor
Second Pet's Name:
Third Pet's Name:
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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