Pet Adoption Application Form

Pet Adoption Application Form

The Lewis County Humane Society believes pet ownership is a serious responsibility and a lifelong commitment. Our goal is to place animals in the best possible home where each adoptive person realizes the obligation to the animals. You must complete this application and be willing to answer specific questions about your lifestyle and personality. The Lewis County Humane Society has the right to refuse any adoption.
Perspective Pet Parent*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Name of Pet You Wish to Adopt*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you at least 18 years of age?*

YesNo
Is this pet going to be a gift?*

YesNo
CURRENT PETS: Canine Pet Name(s)
Breed(s)
Feline Pet Name(s)
Breed(s)
Other Species Pet Name(s)
Breed(s)
Pet's disposition and behavior towards other dogs? State if you have a pet with known aggression toward other animals.
How many pets have you owned in the last 10 years?*
Why do you want to adopt a pet today?
Are your pets current on their vaccinations?*

YesNo
Are all of your current pets spayed or neutered?*

YesNo
Veterinarian Name
Veterinarian Phone Number
Please enter a valid phone number.
Do we have permission to contact above Vet to receive your vetting history?*

YesNo
Do you own or rent your home?*

OwnRentLive with Parents
If you do not own, please provide your landlord's information here:
What is your landlord's pet policy?
Do you have a yard?*

YesNo
Is it fenced? please describe
Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo
Are there children in the home? (If yes, please list ages)*
Does anyone in the home have an allergy to animals? If yes, please explain.*
Have your children been around pets?*

YesNo
How many hours per day would the pet be alone?*
Will your pets be kept mainly inside, outside, or both?*

InsideOutsideBoth
Where will your new pet stay when you are not home?*

CrateLoose in HouseBasementGarageDog House/Outside
If you have to leave town, emergently or planned, where would your pet stay?*
How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*
Please tell us anything about yourself or your home that you’d like us to know, or that you feel would setyou above other applicants:
3 References. Personal, or if you have a professional one pertaining to your pet such as a groomer, please provide.
Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo
Please provide a detailed description:
By clicking the submit button, I agree:
- To the adoption process & interview, which may include a home check/visit.
- My references will be checked including veterinary and personal.
- To the adoption fee and possible Refundable Deposit if animal is not yet fixed.
- To indemnify and hold harmless the Lewis County Humane Society against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
- That the Lewis County Humane Society will disclose any of the pet's known health or behavior issues before adoption is completed.
- That if I no longer want my pet, or am no longer able to care for my adopted pet, I will surrender my pet back to the LCHS and must provide transport.
- That all of the above information is true and accurate.
Date

MonthDayYear
Date
Signature of Potential Pet Parent

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For LCHS Use: Applicant is

ApprovedDenied
Signature of Adoption Counselor:

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