Adoption Application

Laurens County Humane Society Adoption Application
Applicant Information
This questionnaire is designed to help Laurens County Humane Society and yourself determine if a specific animal is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Laurens County Humane Society reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
This questionnaire is designed to help Laurens County Humane Society and yourself determine if a specific animal is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Laurens County Humane Society reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
What Pet (Name) would you like to adopt: *
First & Last Name: *
Street Address: *
City, State, Zip *
Mailing Address if different
Home/Cell Phone: *

Area Code Phone Number
E-mail: *
Employer: *
Household Information
Are all members of your household in agreement with this adoption? *

Yes No
Do you own or rent? *

Own Rent
If rent, does your landlord allow animals? Are there any restrictions? Please provide name and phone number of landlord
If you rent you must list a name & ohone number
Do you have a fenced yard? *

Yes No
Height and type of fence
Do you have any of the following?

Underground fence Kennel Dog Run Doggie Door
How many adults are in your household? *
How many children are there in your household and what are their ages? Have they been around animals before? *
Does anyone in your home have allergies to animals or have asthma? *

Yes No
Current/Previous Pet Information
List all pets you currently and previously owned as an adult (Name, Breed and Age) *
Where are these animals now?
Have you ever surrendered a pet before? If yes, what were the circumstances? *
Are ALL pets past & present Spayed or Neutered?

Yes No
Are ALL pets past & present kept current on their Vaccinations, Flea/Tick and Heartworm Preventatives?

Yes No
What is the name of the Heartworm Preventative used? *
Type NA if you never had a Dog
Have any of your pets had parvo? *

Yes less than 5 years ago Yes more than 5 years ago No
Vet Name & Address: *
Enter N/A if No Previous Pet
VET Phone Number *
Failure to Provide Phone Number will delay your application from being processed
Name of Pets Seen by this Vet: *
If you use Pet Mobile you we need a copy of Pet Records.
Will you call your vet as soon as possible and let them know it is ok to speak to us *

Yes No
If No Vet Listed Above Have You Used Pet Mobile? *

Yes No
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato) *
Where will your new pet live? *

Inside Only Mostly Inside Mostly Outside Outside Only
How many hours each day will your new pet be home alone? *
Where will your new pet sleep at night? *
Where will your new pet stay when nobody is home? *
How will you supervise the pet's outdoor activity? *
Do you understand that a pet can be an 15+ year commitment ? *

Yes No
Have you considered all the time and energy you will need to invest in your new pet? *

Yes No
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

Yes No
What will you do if this pet has or develops behaviorial problems? *
What will you do with this pet when he/she becomes ill or shows signs of health problems? *
What will you do with this pet if you move? *
What will you do with this pet when you go on vacation? *
What circumstances would lead you to give up your new pet? *
If you had to give up your pet, what would you do with him/her? *
Are you finacially able to care for this pet in the manner it deserves? *

Yes No
How did you find out about Laurens County Humane Society? *

Adoptapet.com Petfinder.com Facebook Friend/Family Member
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Thank you for considering opening your heart and home to one of our animals.

We will call you when your application is approved.
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Laurens County Humane Society Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information

Thank you for considering opening your heart and home to one of our animals.