VET REFERENCES WILL BE CHECKED:

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.

Do you live: *

In the City

In the Country

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: Please type your name. *

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

Have you or anyone in your household been convicted of animal cruelty? *

Yes

Pet You're Interested In: *

Date and time

If not employed, last place of empoloyment:

If yes, explain:

Are/Were your current/previous dogs on heartworm preventative? (Everyday store bought wormer does not prevent this, the medication is purchased from a vet) *

Yes

I have not owned any dogs

Who is your most recent vet? Name and Phone Number: *

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

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

Spay.Neuter.Adopt.

Drivers License #: *

Leitchfield Animal Shelter

Adoption Application

Best phone number to reach you. *

Place of Employment: *

Have you adopted with us before? *

Yes

Your Full Name *

If no, please explain why?

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

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

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 pets

Do you understand the Leitchfield Animal Shelter is NOT responsible for medical care AFTER the pet you have adopted goes home and if we make you aware of a health issue before the animal leaves, you agree to continue care? *

Yes

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

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

Yes

270-230-8839 Mon. - Sat. 10:00AM - 3:00PM Sun. 11AM-2PM

Leitchfield Animal Shelter

Print an application to Adopt a Pet

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

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

Do you: *

Own

Rent

Live with Parents

Live with Friends

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

Please list all other adults that will live in the home with the pet: *

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

Yes

City, State, Zip Code *

Address *

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

Yes

Landlord's Name and Phone Number: *

Do you have a fenced yard? *

Yes

Yard is partially fenced

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

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 vetwork listed under? (Your name, your parent, spouse) *

Email *

If No, please explain why?

Secondary number/emergency number. *

213 William Thomason Byway, Leitchfield, KY 42754

Leitchfield Animal Shelter

270-230-8839 Mon. - Sat. 10:00AM - 3:00PM Sun. 11AM-2PM

Leitchfield Animal Shelter

270-230-8839

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