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an application to adopt an animal, please complete the form below.
Bold fields are required. |
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Name:
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Home
Phone:
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Work
Phone:
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Address:
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City:
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State:
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Zip
Code:
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Drivers
license/ID#:
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How
long have you lived at your current address?
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Do
you: Own? Rent? Live with relatives?
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Landlord
Name if you rent:
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Landlord
Phone Number:
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Do
you plan to move soon? (Y or N)
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Do
you work outside the home (Y or N)? If so what hours are you
are gone each day?
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How
many children live in household?
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How
many adults live in the household?
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Annual
amount you intend to spend on this animal?
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| $50-$100 |
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$100-$200
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$200-$300
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$300-$400
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$400-$500
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Over
$500
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Who
are you adopting this pet for? Yourself? Relative? Friend? Pet?
Other?
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Which
LHS animal(s) would you like to adopt? Name and whether cat
or dog - If not a specific animal, what breed are you looking
for?
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Please
list the you currently own - Include type of animal, sex, spayed
or neutered, age, kept indoors/outdoors, current on annual vaccinations:
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| Please
enter the name and phone number of your most recent vet. |
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Please
list the types and breeds of pets you have owned in the last
ten years - Include type of animal, age, how long, and what
happened to him/her?
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How
will you confine your new pet to your property - Fence, dog
run, trolley, stake in ground, other:
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This
pet will be - indoors only, in/out, outdoors only, don't know
yet:
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Where
will the pet be kept during the day:
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Where
will the pet be kept at night:
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By submitting
this application, I certify that the above information
is true. I also understand that giving false information on
this application is grounds for denying my application. This
application remains the property of the Louisa Humane Society.
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Email:
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