Name: Holiday Dinner
Start: 2018-12-02T17:00:00+00:00
End: 2018-12-02T20:30:00+00:00
Location: O Bistro

Who are you interested in?*
Adopter’s Name*
Email*
Enter Email Confirm Email
Home Phone
Cell Phone
Work Phone
Physical Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address (if different than Physical)
Street Address Address Line 2 City State ZIP Code
Current Veterinary Hospital
Vet's Phone
Past Veterinary Hospital
Past Vet's Phone
Is there a name besides yours that vet records would be listed under?
Please list all pets you have owned in the past 7 years:

You do not need to include reptiles or birds on this listing.
Pet #1
Name
Breed
Age
Sex
Spayed/Neutered?
Still owned?
If not, why?
Pet #2
Name
Breed
Age
Sex
Spayed/Neutered?
Still owned?
If not, why?
Pet #3
Name
Breed
Age
Sex
Spayed/Neutered?
Still owned?
If not, why?
Pet #4
Name
Breed
Age
Sex
Spayed/Neutered?
Still owned?
If not, why?
Pet #5
Name
Breed
Age
Sex
Spayed/Neutered?
Still owned?
If not, why?
Pet #6
Name
Breed
Age
Sex
Spayed/Neutered?
Still owned?
If not, why?
Why are you looking to adopt (check all that apply)?*
- Protection
- Companion
- Mouser
- Gift
- Breeding
- Other
What type of residence do you utilize?*
Do rent or own your home?*
If renting or living with the home-owner provide your Landlord’s first and last name:
First Last
Landlord's Phone Number:
Who will become this pet’s guardian if you lose your home, move or are no longer able to care for this pet?
Please list the names and ages of everyone living in your household:
Resident #1
Name
Age
Resident #2
Name
Age
Resident #3
Name
Age
Resident #4
Name
Age
Resident #5
Name
Age
Resident #6
Name
Age
Have you adopted from LRHS in the past? If yes, when and whom?
Have you ever had to surrender an animal? If so, please explain:
Are you willing to dedicate 2-4 months to helping this pet adjust to your home?*
Are your current pets to date on rabies & distemper vaccinations?*
Are your current pets spayed/neutered?*
If no, why?
Where will your new pet spend most of its time?*
Thank you for considering the Lakes Region Humane Society for your new pet!

I, the adopter, pledge that the information provided within this Adoption Application is correct and true.
Adopter's Initials*
By initialing here, you agree to the above.
Date*
CAPTCHA

Lakes Region Humane Society

Providing a safe and compassionate shelter for lost, abused or unwanted animals since 1995

The Lakes Region Humane Society cares for cats and dogs in need until they can be adopted, and promotes their health and welfare through community outreach and education.

Thinking of Adopting?

Adopting from LRHS gives you an opportunity to meet and bond with your future pet before making a commitment to adopt while providing a pet with a warm and loving home.

Volunteer today - make a difference in a pet’s life and in yours!

Whether your preference is dog walking, cat cuddling, office work or getting down and dirty to help clean, we will be sure to find a job for you!

There are many ways to donate to LRHS!

Monetary donations or donating items on our wish list like fleece fabric, Pedigree Chicken canned dog or poultry based cat food: find out how you can make a pet’s life a little brighter today!

Online Adoption Application

Please list all pets you have owned in the past 7 years:

Pet #1

Pet #2

Pet #3

Pet #4

Pet #5

Pet #6

Resident #1

Resident #2

Resident #3

Resident #4

Resident #5

Resident #6

Thank you for considering the Lakes Region Humane Society for your new pet!