EmailMeForm
Small Animal 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 and valid driver's license 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
*
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
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.) living 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?
*
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.
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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What kind of animal do you want to adopt?
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Rabbit
Ferret
Guinea Pig
Hamster
Rat/Mouse
Bird
Other
If other, please explain:
Do you have a cage or pen for your pet?
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Yes
No
What are the dimesions of this cage or pen?
Are you willing to allow this pet to exercise outside their cage or pen?
Yes
No
Do you have a secure area to keep this animal in your home?
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Yes
No
Do you have the necessary supplies/room to provide for your pet?
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Yes
No
Do you agree to take your pet to a veterinarian if they become ill or injured?
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Yes
No
How much are you willing to spend on medical bills if your new pet were to suddenly become ill or injured?
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Up to $100
Up to $500
Up to $1,000
Whatever it takes
What would you do if the bill exceeds this amount?
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Estimate the yearly cost of a pet in your care. This includes, but is not limited to, the cost of food, medications, veterinary care, grooming, etc.
*
Have you owned this type of animal before?
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Yes
No
If no, what type of research, if any, have you done to prepare for adopting this animal?
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Who will be responsible for your pet's care?
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Under what circumstances will you absolutely not keep this pet?
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Why are you interested in adopting this pet?
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*I acknowledge that if any information is false or misleading my application it is subject to denial.
Signature
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Clear
Date
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MM
/
DD
/
YYYY
Upload valid photo ID
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Upload proof of residence, if not shown on photo ID