Do you: *

Own

Rent

Live with Parents

Live with Friends

Are/were your current/previous pets spayed or neutered? If no, please explain why: *

If you do not have a fenced yard, how will you supervise your pet when outdoors? *

Leash Walk

Run Loose

kennel

Chain Cable runner/Tie Out

Live on a Large Farm or rural Area

Electric Fence

I will be outdoors with my pet

Pet will not be outdoors

Drivers License #: *

ABOUT THIS APPLICATION

If No, please explain why?

Date and time

Do you have a problem with us doing a follow up call or visit? *

Yes

What vet do you currently use or used in the past? Name and Phone Number: *

If yes, What did you adopt and how long ago?

Type of Dwelling: *

House

Condo

Apartment

Mobile Home

Shelter Care Insurance is a free 30 day health insurance that comes w/ the adoption of your new pet. Your new pet will be signed up for this insurance before he/she leaves the shelter, but you must acknowledge your membership via email for it to begin. This does not include all pets under the age of 8 weeks. *

Yes

270-230-8839 Monday - Saturday 10:00 AM - 3:00 PM

ABOUT WHERE YOU LIVE

If you are requesting the adoption of an animal that we feel needs a fenced yard or special attention do you agree that we may do a home visit before the animal goes home to verify that your home does have a fenced yard? *

Yes

If yes, please explain (stray, divorce, etc.

If Yes, please indicate how many children and their ages: *

Are/Were your current/previous pets current on yearly vaccines, such as Rabies? *

Yes

I have not owned any dogs

If you give up this pet for any reason, do you understand that you MUST bring the animal back to this shelter? *

Yes

What Name(s) is the Vet Work listed under? (Your name, your parent, spouse) *

Email *

Check here to receive email updates

List pets that you no longer have & Why (Be specific ` if they died, explain how, if they were given away, explain why) *

Your Name & Pet Your Interested In: *

Electronic Signature: Please type your name. *

Are/Were your current/previous dogs on heartworm preventative? *

Yes

I have not owned any dogs

Do you understand it is mandatory that this pet be microchipped? This is already included in the adoption fee. *

Yes

Are there any children in your household or ones that make regular visits to your home *

Yes

List pets that you currently own: What are your Pets Names, Breeds, Male or Female *

Are your pets current on vaccines? *

Yes

Do you understand if we feel the animal you have chosen is not likely to work out in your situation, we may decline the application, FOR ANY REASON? We will work with you to reccomend an animal that best suits your needs. *

Yes

Your Name & Pet You're Interested In:

Best phone number to reach you. *

Place of Employment: *

Do you agree to keep this pet on flea & tick preventative *

Yes

Landlord's Name and Phone Number: *

If no, please explain why?

GENERAL QUESTIONS

Secondary number/emergency number. *

Birth Date: *

If the Submit Button is not highlighted, you missed a question that is required. Please review the form and answer each question as requested.

City, State, Zip Code *

Street Address *

What is the estimated distance from your road to your house? *

If you live with your parents, Parent's Name and Phone Number:

Do you understand that if ANY of the information on this application is found to be false, or if we find the animal you are adopting from us is not being given proper care (personal or veterinarian), we WILL reclaim the animal, this includes living situations not being the same as on this application? *

Yes

Electronic Signature:

213 William Thomason Byway, Leitchfield, KY 42754

"Don't Shop. Adopt."

Adoption Application

Do you live: *

In the City

In the Country

Have you surrendered a dog or cat to an animal shelter or rescue group? *

Yes

Do you have a fences yard?

Yes

Leitchfield Animal Shelter

Have you adopted with us before? *

Yes

270-230-8839 Monday - Saturday 10:00 AM - 3:00 PM

Leitchfield Animal Shelter

Leitchfield Animal Shelter

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270-230-8839