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"The greatness of a nation and its moral progress can be judged by the way its animals are treated." ~ M. Gandhi

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Name of Pet Interested in/Dog or Cat:
If not a specific animal, what breed are you looking for?



Street Address


Cell Phone:
Home Phone:
Work Phone:

Do you work outside the home
(Y or N)?


If so, how many hours are you away from the house?

Where will your pet spend his or her time when you are out?

Where will your pet be if you go on vacation?

Annual amount you intend to spend on this animal?

Who are you adopting this pet for?

Name of Employer or School:

Own? Or Rent?:
If Rent, please provide the name and number of landlord:
If Own, how many years?

How many people live in your home? (Please provide ages and relationship)


Have you ever had to surrender a pet (If yes, please list reasons)?


Have you ever declawed a cat or plan to declaw your new cat (if applicable)?



Please list the pet you currently own - Include type of animal, sex, spayed or neutered, age, kept indoors/outdoors, current on annual vaccinations:






Current on vaccinations


Please list the types and breeds of pets you have owned in the last ten years - Include type of animal, age, how long, and what happened to him/her?



How Long

What happened?

Please enter the name and phone number of your most recent vet:

Name of Veterinary Practice:

Telephone Number:

Name Account is Under:

Names of pets that have been seen by the vet:

If you have never had a pet, please provide us with the names and telephone numbers of three personal references:

Reference #1:

Name/Relationship (friend, relative, etc.):


Best number to reach them on:

Reference #2:

Name/Relationship (friend, relative, etc.):


Best number to reach them on:

Reference #3:

Name/Relationship (friend, relative, etc.):


Best number to reach them on:



What characteristics are you looking for in a dog?

Where will your pet sleep at night?

How many hours will your dog spend outside per day?

My pet needs to be good with:  Children?  Elderly People? Cats?  Other dogs?  Animals other than dogs and cats.  Please list.

My pet should have:  High, medium, or couch potato energy?

What “normal” dog behavior challenges are you prepared to deal with? (e.g., chewing, housebreaking, barking etc.)

What behaviors concern you the most?  Would these cause you to return the dog to us?

What exercise plans do you have for your dog?  Do you plan on hiring a dog walker?  Enrolling in obedience school?

How will you confine your new pet to your property?

How did you find out about the pet you are applying for and what drew you to him or her?

By submitting this application, I certify that the above information is true. I also understand that giving false information on this application is grounds for denying my application. This application remains the property of the Louisa Humane Society.


Thank you for your interest in adopting!!!

Having trouble with this form?
It happens from time to time, and we are sorry
that it happened to you!
Below is a downloadable form that you can print,
complete and mail in.

Download Adoption Application here (88k PDF)