EmailMeForm
Dog Adoption Application
Thank you for considering adopting from La Plata County Humane Society. You are not only finding a new family member, but you are giving an animal a second chance at a new life.
Please upload a copy of your current photo ID and proof of residence if not shown on your identification.
La Plata County Humane Society reserves the right to decline or postpone any adoption. I acknowledge that if any of the information on this application is false or misleading it is subject to denial.
For questions regarding the application process, please call (970) 259-2847.
Full Legal Name
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First
Last
Phone
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Secondary Phone
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Physical Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Email
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Spouse/Emergency Contact (Full)
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First
Last
Spouse/Emergency Contact Phone
*
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What type of dwelling do you live in?
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House
Apt/Condo/Townhome
Mobile Home/RV
Dorm
Other
If other, please explain:
Do you rent your home or lot?
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Yes
No
Name of complex or mobile home park:
Landlord's name:
First
Last
Landlord's phone:
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How long have you lived at your current address? If less than two years, what is your previous address?
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Address:
Street Address
City
State / Province / Region
Postal / Zip Code
Please answer the following questions:
List all persons (yourself, adults, children, roommates, frequent visitors, etc.) at your current residence.
Name
Relationship
Age
Date of Birth
Full Legal Name
Full Legal Name
Full Legal Name
Full Legal Name
Full Legal Name
Full Legal Name
Is anyone listed above allergic to animals?
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Yes
No
Does everyone living in your residence know about and agree to your decision to adopt?
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Yes
No
Please list all pets that live at or visit your current address. NOTE that if you have other adult dogs in your home, you will be required to bring them for a meet and greet before an adoption can take place.
Write "none" in animal "type" if no pets.
Type
Name
Breed
Age
Sex
Altered? Y/N
Length Owned
Indoor/outdoor, both?
Animal
Animal
Animal
Animal
Animal
Animal
Have you owned a pet in the last five years that is no longer with you?
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Yes
No
If yes, what happened to the animal?
Who is your current Veterinarian?
Veterinarian Name
First
Last
Phone
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How much are you willing to spend on medical bills if your new dog were to suddenly become ill or injured?
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Up to $100
Up to $500
Up to $1,000
Up to $5,000
Whatever it takes
What would you do if the medical bill exceeds this amount?
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Estimate the yearly cost for a dog in your household. This includes, but is not limited to, the cost of food, medication, veterinary care, grooming, boarding, etc.
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On a typical day, I am
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Mostly at home
Out part time (4-6 hours)
Away for more than 8 hours
Where do you plan to keep your new dog when you are not home?
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Where do you plan to keep your new dog at night? Inside/outside?
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Do you have a yard?
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Yes
No
Is it fenced?
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Yes
No
If yes, fence height?
How would you describe the level of activity of your household?
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Who will ultimately be responsible for feeding, socializing and training your new dog?
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What pet behavior problems have you experienced in the past, and how would you resolve them?
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Do you plan to move or go on an extended vacation in the next six months?
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Yes
No
If you have to move, what do you plan to do with your new dog?
Changing an animal's environment may cause changes in behavior, or accidents in the house, that we at LPCHS cannot anticipate. How do you plan to deal with this?
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On average, it may take your new dog one month or longer to adjust to its new home and routine, especially if you have other pets. Are you willing to allow for this adjustment period?
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Yes
No
Under what circumstances will you absolutely not keep this dog?
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Name of dog you are interested in?
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Why are you interested in adopting this particular dog?
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*I acknowledge that if any information is false or misleading my application it is subject to denial. We reserve the right to refuse adoptions.
Signature
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Clear
Date
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MM
/
DD
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YYYY
Upload valid drivers license or government issued ID
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Upload proof of residence, if not shown on photo ID
Web Site
Web Site
