First Contact Form Today's Date * I am registering for: *Tier-1, "I'm committed to adopting" ($50 service fee)Tier-2, "I'm considering adopting" ($25 service fee) Name * Address * Suite / Apt # City * State * Zip * Do you own or rent/lease this address? *OwnRent/Lease Landlord Name and Phone Number (Mandatory if you rent or lease):Applications without valid landlord phone number will be rejected. Records will be checked. Drivers License Number (or other valid ID) *Applications without drivers license (or other valid ID) number will be rejected. Please include the state where your license was issued. Phone * Will you accept text messages? *YesNo Email * Date of Birth *You must be 18 years of age (or older) to adopt. 18 Years or Older? *YesNo In the past, have you adopted from:LHSAnother shelter How soon are you hoping to adopt? * If you currently have pets in your home, please list types/breeds and ages: If you have small children at home, please list age of each child:* Does anyone in your home have animal allergies? *YesNoUnknown This pet will live primarily:*IndoorsOutdoorsBoth This pet will sleep: *IndoorsOutdoorsBoth How many hours a day will the pet be left alone: * What type of pet are you seeking? *DogCatOther Preferred gender *MaleFemaleNo preference Preferred breed *Please provide at least 1 breed (or breed mix). Remember that this is a service to match you to your ideal pet. "Any" or "all" will not be accepted. Have you worked with this breed/these breeds before? *YesNo Preferred age *Under 6 months6 months to 1 year1-3 yearsOver 3 yearsOther Energy level *I can adjust my lifestyle to fit my pet's needsLow (light exercise/lots of down time)Medium (daily walk/daily play time)High (daily walk or jogging/LOTS of play time) Grooming needs *No preference/any level of groomingMinimal/light brushingRegular upkeep/regular brushing and detanglingHeavy upkeep/professional grooming and clipping Other preferences *Likes catsLikes dogsLikes kidsCan be crated/left alone much of the day Alternate Contact Name and Phone Number * Required by microchip company. What circumstances, if any, would cause you to relinquish this pet in the future? By submitting this completed form, I state that I understand and agree with the process and expectations associated with the service Tier (Tier-1 or Tier-2) option that I have selected. I also understand that forms with missing or incorrect information will be rejected. *I agree.
