Drivers License #: *

Leitchfield Animal Shelter

Adoption Application

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

Best phone number to reach you. *

Place of Employment: *

Have you adopted with us before? *

Yes

Your Name *

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 fences yard?

Yes

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:

ABOUT THIS APPLICATION

If No, please explain why?

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

Pet You're Interested In: *

Electronic Signature:

Date and time

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

Yes

Electronic Signature: Please type your name. *

Secondary number/emergency number. *

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

Yes

I have not owned any dogs

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?

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

Yes

Type of Dwelling: *

House

Condo

Apartment

Mobile Home

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

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: *

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

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

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 *

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GENERAL QUESTIONS

Spay.Neuter.Adopt.

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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