Adoption Application

Applications must be filled out completely. Must be 21 years of age to adopt. Cat/Kitten fee $60.00, Dog/Puppy fee $70.00, Two cats or kittens - $90.00 fee for same day adoptions. Senior Citizen Rates (55+) for cat/kitten fee - $30.00, puppy fee $70.00, dog (5 years or older) - $35.00. There is a pre-home visit before a dog may be adopted (references must be supplied).

Fill out the form below and press "Submit Application" or download the Application form here to fax, mail or bring in.

*Name
Address
City Zip
*Home Phone
Employed at
Work Phone
Type of Housing	Own House  Rent House  Rent Apartment
Years at this address	years
Previous address (if less than 5 years)
If you rent, what is your landlord's name?
Landlord's phone?
# of Adults in household
# of Children	Ages
Allergies?
Why do you want a pet?
Why do you want this specific pet? (please type pet's name here)
Who will be responsible for the pet’s care?
Will the pet stay inside or outside?	Inside  Outside
Do you have an enclosed yard?	Yes  No
What are the approximate dimensions?
Will you allow home visits to observe the animal in its new surroundings?	Yes  No
Do you understand how long pets can live and the financial responsibility involved?	Yes  No
Have you ever adopted an animal from an animal shelter?	Yes  No
When?
Type?	Dog  Cat  other
Have you ever taken an animal to an animal shelter?	Yes  No
When?
Type?	Dog  Cat  other
Please explain why
Current Pets: Please include all pets, including small caged ones or barn animals   Type Age Sex Spayed/Neutered Inside/Outside Years Owned 1 F  M  Yes  No  Inside  Outside  2 F  M  Yes  No  Inside  Outside  3 F  M  Yes  No  Inside  Outside  4 F  M  Yes  No  Inside  Outside
Do you have a Veterinarian?	Yes  No
Your Veterinarian's name
Pet History: Please list any pets owned in the last 5 years other than those above   Type Age Sex Spayed/Neutered Inside/Outside Years Owned 1 F  M  Yes  No  Inside  Outside  2 F  M  Yes  No  Inside  Outside  3 F  M  Yes  No  Inside  Outside  4 F  M  Yes  No  Inside  Outside
Please provide two references with telephone numbers (other than a Lakeshore Humane Society volunteer)
Reference #1
Reference #2
All information above is truthful. Should any be found false, and an adoption has been approved based on the above information, the adoption will be terminated. Your initials