Applicant Must be 18 years or Above

Adoption Application

This form is used for adopters and interested parties.

Contact Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Date of Birth(Required)

Age(Required)

Please enter a number from 1 to 100.

IS/Driver's License(Required)

Are you currently:(Required)

Living Arrangement

What type of home do you live in?(Required)

Do you:(Required)

Does your landlord allow pets?

Yes, only 1

Yes, only 3

Yes, 3 or more

Landlord Name

First Last

Landlord Phone Number

Length of time at your current address:(Required)

Do you plan on moving in the foreseeable future? If so, where will you move and why?(Required)

Are all members of your household aware of and in agreement with this adoption?(Required)

Are any members of the household allergic to cats or dogs?(Required)

Who lives with you? Please list all children, their ages, and adults in the home your pet will reside.(Required)

Have you owned any animals in the past 10 years?(Required)

Can you afford to care for your pet (food, supplies, veterinary bills, etc)?(Required)

Do you have a veterinarian?(Required)

Who is your Veterinarian?

Do you currently have pets?(Required)

What pets do you currently have?

How will you introduce your new pet to any existing pets?

When inside, how do you plan to keep your pet?(Required)

When outside, how do you plan to keep your pet?(Required)

How do you plan to handle undesirable behavior (chewing, barking, accidents, scratching furniture, getting onto countertops, etc.)?(Required)

Adoption Information

I want to adopt a (check all that apply):(Required)

Cat

Dog

Male

Female

No Preference

What is the name of the animal you are hoping to adopt?

Why do you want to adopt this pet (check all that apply)?(Required)

Companionship

My children will learn to be responsible for and to care for another creature

Want to breed

Looking for mouse/rodent control for home

Feel sorry for the animal. The animal is so cute I can't leave it behind

Gift for someone

Companion for another pet

Other

Please state whom and the age of the person who will be primarily responsible for the pet.(Required)

Signature

Need Assistance with a Stray Animal?
Please contact Animal Control at
(352) 343-9688

The Leesburg Humane Society, Inc is a registered 501(c)(3) charitable organization

Adoption Application

Contact Information

Living Arrangement

Adoption Information

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