Adoption Application

Leavenworth County Humane Society is a 501(c3) corporation, staffed by volunteers. We operate from a small temporary shelter until we raise the funds to build and operate the community animal resource center that Leavenworth County residents need, want, and deserve. We also employ volunteer foster homes. We are a licensed pet animal shelter under the Kansas Department of Agriculture, Kansas Pet Animal Act.

Our adoption fees cover only part of the routine cost of taking in and caring for the pets. Collecting an adoption fee allows us to continue our work. Adoption fees for dogs range from $125 to $250; adoption fees for cats range from $90 to $150. Fee is set based on size, age and breed.

All of the pets in LCHS, Inc. care see a veterinarian regularly. We provide core vaccinations. Pets are protected from parasites by preventatives. Cats are tested for FIV/FeLV; dogs are tested for heartworm. Pet dogs and cats are microchipped.

The state requires that pet dogs and cats are spayed or neutered prior to adoption unless there is a documented reason to postpone that procedure. If that is the case, we are required to collect a spay/neuter bond ($100 for dogs; $50 for cats) in addition to the adoption fee. Once proof of sterilization is provided, the spay/neuter bond is refunded.

We normally spay/neuter and complete vaccinations prior to adoption.

We prefer that animals in our care go to homes where they will be indoor family pets, and will be supervised and controlled when outdoors by fencing or a leash.

We consider applications in the order we receive them, but select the home that we feel is the best fit for that particular pet.

Please provide a brief answer to each question below. If you have any questions, contact us at LvnCoHS@live.com or 913-250-0506.

Name of Pet you are interested in

Or type of pet you would like to adopt

DogCat

Applicant Name*

DL #

Address*

City, State, Zip*

E-mail*

example@example.com

Primary Phone*

Secondary Phone

Date of Birth*

Date

Work Phone

Veterinarian

The facility that would have your pets current records.

Veterinarian's Address:

Veterinarian's Phone:

How did you learn about this pet / LCHS, Inc. ?

Leavenworth County Humane Society, Inc. Adoption Application Page 2

Number of persons in your household:

Age of youngest person:

Resident companion animals:

	Species	Breed	Name	Gender	Age	Years owned
Animal One
Animal Two
Animal Three
Animal Four
Animal Five
Animal Six
Animal Seven
Animal Eight
Animal Nine

Please describe your home (Click all that apply.)

Years there?

My pets are spay/neutered:

YesNo

My pets are current on standard vaccinations:

YesNo

My pets are on heartworm preventatives:

YesNo

My pets are on flea preventatives:

YesNo

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

Please tell us anything else you think might help us understand the kind of home you would offer to a pet:

Did someone with LCHS, Inc. suggest you adopt from us? Please let us know so we can thank them!

Do you consent to receiving communications from LCHS, Inc. in the future via email, phone, text, and/or postal mail?*

YesNo

I agree by submission of this form that LCHS, Inc. may verify the information I’ve provided. I also understand that LCHS, Inc. may conduct an internet background check and view my public presence on social media.

Printed Name*

Date*

Date

Signature*

LCHS, Inc. complies with all applicable laws and regulations regarding non-discrimination and equal opportunity with respect to clients, officers, employees and volunteers.