Lawrence County Humane Society

Adoption Application Form

Please fill in as many boxes as you can.

Click on the Submit button at the bottom of the page when ready to send.

Name of pet you are interested in:
Date:
Your name:
Address Street:
City:
State:
Zip:
Email address (required):
Home phone:
Work phone:
Best time to call:
Employer:
Employer's phone:
Veterinarian's name:
Veterinarian's phone:
Veterinarian's city and state:
Your age:
Your spouse's age:
Do you own or rent:
Landlord's name:
Landlord's phone:
Would you accept a dog that has been abused?:
Who will be primary caregiver of animal?
Working hours of adults in home:
Size of yard:

List people living in house, ages, and relationship to adopter.

Current pets living in the house and their ages.

Current pets living outside and their ages.

Which current pets have been spayed or neutered?

Do you have a securely fenced yard? If so, how tall is fence.

Do children visit your home.

Are any members of household frail or sickly.

Where will pet be kept during the day??

Where will pet be kept at night??

 

Where will pet be kept when family is home?

Where will pet be kept when no one is home?

How many hours will the pet be left alone each day?

Are you willing to give the pet six weeks to adjust to new environment?

Will you accept a home visit?

Do you anticipate any major changes in your job or family in the next year?

List any characteristics of an animal that would not fit with your family or lifestyle.

Other information that you would like to include: