Lakeshore Humane Society

Small Animal and Rabbit Pre-Adoption Application

Please answer these questions to the best of your ability.  Doing so truthfully and honestly will help us to match your needs with the pet you would like to adopt.  Once your application is received the Lakeshore Humane Society staff will use it as a tool to place the pet in the most appropriate adoptive home.  Thank you for visiting our shelter's web site!  

Just complete this form. Click on Submit when ready to send.


Your Name:

Spouse/Partner's Name:

Home Phone:                Work Phone:
    

Address:


City:


State:


Zip Code:


Your Email Address:  


What pet are you interested in adopting? Please provide Pet Name (if available ) and ID Number.

Who is this Pet for?


Why do you want this pet?


What amount of time and effort are you willing to devote to this pet?


Do you live in a house, apartment, town house, mobile home?


Do you own or rent? If you rent what is your landlord's name & phone number?


How long during the average work day will the pet be left alone?


Do you have children? What are their ages?



Are you prepared for the financial responsibility of pet ownership? Routine medical care, food, toys…


Does anyone in your family have pet allergies? If yes, please explain.

Where will the pet live?     Inside Outside Both

Where will the pet sleep at night?


Do you have any other pets in your household?  Please describe, listing the name, type, sex, age, where kept and whether or not they are altered.


If you currently own or have had pets in the past what veterinary clinic do/did you use? Name, Phone, who is pet listed under?


Are you willing to keep this pet for it's lifetime?
Yes No

Please list two non-related references and their phone numbers:


How did you learn about this pet?
Website Friend Shelter Visit NewspaperOther

I certify that the information I have provided is true and that I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a pet. I understand that the Lakeshore Humane Society, Inc. has the right to deny my request to adopt an animal and I authorize investigation of all statements in this application.

    I agree to the above statement:            I disagree to the above statement:          


Any Additional Comments:



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