First Contact Form

Today's Date *

Month

Day

Year

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? *

Own

Rent/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? *

Yes

No

Email *

Date of Birth *

Month

Day

Year

You must be 18 years of age (or older) to adopt.

18 Years or Older? *

Yes

No

In the past, have you adopted from:

LHS

Another 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? *

Yes

No

Unknown

This pet will live primarily: *

Indoors

Outdoors

Both

This pet will sleep: *

Indoors

Outdoors

Both

How many hours a day will the pet be left alone: *

What type of pet are you seeking? *

Dog

Cat

Other

Preferred gender *

Male

Female

No 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? *

Yes

No

Preferred age *

Energy level *

I can adjust my lifestyle to fit my pet's needs

Low (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 grooming

Minimal/light brushing

Regular upkeep/regular brushing and detangling

Heavy upkeep/professional grooming and clipping

Other preferences *

Likes cats

Likes dogs

Likes kids

Can 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.

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