LHS Adoption Form

Contact Information

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Cell Phone*

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What is the name of the animal are you interested in?*

If your desired pet is not on the list above, please describe it below. Be sure to include color/breed/etc..

What is the age of the person submitting online application. *

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Residence Information

What is the total number of people residing in the household?*

Please list the ages of all household members other than applicant, including all children.*

Residence Type*

Is anyone in the house allergic to animals?*

Yes

Does anyone in the home require continuous mental or physical care?*

Do you own the home you're living in?*

Yes

Describe the type of fencing your home has. IE: 6ft Wood Fence / Chain link / wrought iron*

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Pet Information

Why are you looking for a pet?*

Do you currently own a pet?*

Yes

If so, what kind of pet(s)?

Please select all services your animals has received. To select more than one line hold the "ctrl" key down and click on each option you would like to add.

Vet's contact information*

Have you owned a pet/s in the last 5 years that is no longer with you? If so, what happened to the pet/s?

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Pet Information (Continued)

How many hours a day will your pet be left alone? Please enter a number 1-24 or "zero". *

Where will your pet be kept during the day?

Where will your pet be kept at night?

What behaviors can you tolerate with a new pet?

If you can't handle any of the behaviors above, briefly explain how you would handle the problem

What will you do with your pet when you leave town?

What happens to the pet if you have to move?*

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Final Questions

How did you hear about us?*

Would you be interested in fostering for LHS?*

Yes

Do you certify that all information that you provided is accurate?*

Yes

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