Adoption Application - Licking County Humane Society

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This application is: *	For an Adoption To become a Foster Parent
Pet's Name:
I am interested in:	A Cat A Dog
Your Name *
Address:
Email: *
Home Phone:
Cell Phone:
Work Phone:
How many adults are in your home?
How many children are in your home and what are their ages?
Do you own your home or rent?	Own Rent
Does your Home Owner's Assoc or Landlord allow pets?	Yes No
Please provide contact information for your Home Owners Assoc or Landlord:
Do you have a fenced in yard? If so, how high is your fence?
Who is your vet? Please provide contact information and phone number:
Please provide two additional references. Reference #1:
Reference #2:
How many hours a day will your new pet be left alone?
Please describe the area where your pet will spend its day:
Please describe the area where your pet will sleep at night:
My pets live indoors:	Yes No Other
Please describe the animals currently living with you (pets name, type, age, sex, spayed or neutered). This is required for your vet reference:
What pets have you had in the past? (Please list type of animal, how long owned and what happened to the pet.):
Who will be the primary care giver for this pet?
Does anyone in your home have allerigies to dogs/cats?
I am prepared to take care of this animal for the next 10-15 years	Yes No Depends
I am financially prepared to deal with the cost of both routine (vaccine, yearly check, dental, HW preventive) and non-routine/emergency veterinary care of this dog/cat.	Yes No Depends
What is the best time to contact you?
How did you hear about us?

LCHS Adoption/Foster Application