Laurens Sheriff's Animal Shelter Adoption Application
79 Mt. Vernon Church Road Laurens, SC 29360 864-682-4935
Applicant Information
Name
First Name
Middle Name
Last Name
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Age (18+)
Yes
No
Residence Type
Please Select
House
Apartment
Condo
Other
Do you Rent or Own
Please Select
Own
Rent
Housing and Household Details
Are pets permitted by your landlord?
Yes
No
Landlord Name
Landlord Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Number of Adults
Number of Children and Ages
Any household pet allergies?
Yes
No
If yes, please explain
Adoption and Pet Information
Pet Applying For
Why do you want to adopt this pet?
Current & Previous Pets
Are all current pets spayed/neutered?
Yes
No
Are all current pets current on rabies vaccinations?
Yes
No
Veterinarian Name & Phone
Where will the pet stay during the day?
Where will the pet sleep?
How many hours per day will the pet be left alone?
Who will be primarily responsible for the pet's care?
References and Sign-off
Reference Name
Relationship
Reference Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Applicant Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Approved
Yes
No
Staff Initials
Shelter Use Only Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Notes
Submit
Submit
Should be Empty: