Dog Adoption Application | Humane Society of Lebanon County

Thank you for taking the time to fill out this application.

We realize that adopting a new furry friend can be very exciting and emotional, as it’s such an important and life-changing decision! Because of this, we are very thorough in our adoption process, making every effort we can to find the best possible match for a forever home for each of our animals here at the Humane Society of Lebanon County.

Therefore, adoption applications are NOT approved on a “First-Come, First-Served” basis, animals are NOT “put on hold,” and we reserve the right to deny an adoption application based on our discretion to place our animals in the best possible home environment.

Please be patient with us regarding the time it takes for us to process your application.

Please answer ALL questions. Incomplete applications will cause your application to be delayed or denied.

Your Driver’s License or Photo Identification Card is Required.

Let's Get Started!

Name of Dog for which you are applying: *

Your Name: *

Your Age: *

Address *

City: *

State: *

Zip: *

Phone Number: *

Email *

Confirm Email

Will this dog be an: *

Outdoor Dog (Dog will live in kennel outside)
Indoor Dog (Dog will live inside the home)
Outdoor/Indoor Dog (Dog will live outside for part of the time)

Tell Us About Yourself!

Your Occupation: *

Employer:

Employer Address:

Employer Phone:

What is your daily work or at-home schedule? *

Spouse's Name

Your Spouse’s Occupation:

Spouse's Employer:

Spouse's Employer Address:

Spouse's Employer Phone:

What is your spouse’s daily work or at-home schedule?

List Names and Ages of Any Children Living with You and Their Relationship to You: *

Tell Us About Your Home...

If you rent your home, please list the name and phone number of your landlord:

How long have you lived at this location? *

Does Your Home Have a Fence? *

If you currently have other dogs in your home, you are required to bring them to the Humane Society of Lebanon County for a “Meet & Greet” with the dog you are interested in adopting. Are you willing to do this? *

Yes
No
There are no other dogs in the home

Tell Us About Your Other Pets...

Please list other animals currently in your home:

Animal #1 Name:

Species

Breed

Age

Sex

Male
Female

Spayed/Neutered

Temperament with people

Temperament with other animals

Animal #2 Name:

Species

Breed

Age

Sex

Male
Female

Spayed/Neutered

Temperament with people

Temperament with other animals

Animal #3 Name:

Species

Breed

Age

Sex

Male
Female

Spayed/Neutered

Temperament with people

Temperament with other animals

Please list additional animals currently in your home:

(Please list name, species, breed, age, sex, spay/neuter status, and temperament for each additional animal.)

Tell Us About The Pets You’ve Had Before...

Please list prior animals and what happened to them.

Animal #1 Name:

Species

Breed

Age

Why do you no longer have this pet?

Animal #2 Name:

Species

Breed

Age

Why do you no longer have this pet?

Animal #3 Name:

Species

Breed

Age

Why do you no longer have this pet?

Please list additional prior animals and what happened to them.

(Please list name, species, breed, and age for each additional animal.)

Tell Us About Your Plans For This Dog...

How much daily time do you estimate you will be able to spend with this dog? *

Where will this dog stay when you are not at home? *

Do you agree with crate-training your dog? *

Where will this dog sleep at night? *

What do you do - or plan to do with your animal(s) while you are on vacation? *

How much money do you expect to have to approximately spend on this dog each year (this includes a minimum of annual check-ups, vaccinations, and food)? *

Please describe any situation that would cause you to give up a pet: *

Please tell us about any research you have done to familiarize yourself with this breed of dog: *

Personal References...

(Please Do NOT List Family Members)

Reference #1 Name: *

Address *

City *

State *

Zip *

Phone *

Relationship to you (Relative, friend, co-worker): *

Reference #2 Name: *

Address *

City *

State *

Zip *

Phone *

Relationship to you (Relative, friend, co-worker): *

Your Veterinarian...

To expedite the application process, please provide us with proof of your current pets’ up-to-date vaccines and spay/neuter documentation.

All dogs and cats within the home must be spayed or neutered prior to adopting a new pet from the Humane Society of Lebanon County, unless otherwise specified in writing by your veterinarian.

(If this is your first pet, please list the veterinarian you plan to see for the care of your dog)

Veterinarian Name: *

Address: *

City: *

State: *

ZIP: *

Phone: *

May we contact your veterinarian for a reference? *

Yes
No
This is my first pet

If Yes, please contact your veterinarian to give permission to release your information to our staff.

Acknowledgement and Release...

I declare that the information I have provided in this application is complete and correct. *

I declare that I have never been convicted of, or cited for, animal cruelty. *

I declare that I have never surrendered an animal to an animal rescue organization or shelter. *

I further declare that I am financially and physically able to care for this dog. *

I understand that proper food and veterinary care may be costly, and that I am willing and able to meet the needs of this dog. *

I understand the requirement and grant permission for the contact of the personal and veterinarian references I have provided, and that the Humane Society of Lebanon County will verify with my landlord (if applicable) that I am permitted to have this dog at the property at which I reside. *

I understand that I am entering a legally binding contract that requires me to return this dog to the Humane Society of Lebanon County if I no longer want it or can properly care for it. *

I understand and agree that I am not permitted to give away or sell this dog to another party and that I will be fined $500.00 and may be prosecuted by law if I break this agreement. *

I submit that if it is found that the information I provided is false or a misrepresentation of any facts, the Humane Society of Lebanon County reserves the right to refuse adoption or to nulify the adoption and reclaim said dog from my premises without reimbursement of the adoption fee. *

I understand and acknowledge that if this dog is not spayed or neutered prior to adoption, I must transport the dog back to the Humane Society of Lebanon County for said spay/neuter at a time mutually agreed upon by both parties. The cost of spay/neuter is included in the adoption fee. Furthermore, I understand and acknowledge that if I fail to return the dog for said agreed upon spay/neuter appointment, the Humane Society of Lebanon County has the right to reclaim said dog from my premises without reimbursement of the adoption fee. *

I understand and acknowledge that The Humane Society of Lebanon County has the right to deny my adoption application based on their discretion in their effort to place the dog in the best possible home environment. *

I understand that The Humane Society of Lebanon County recommends that I take my newly adopted dog to a qualified veterinarian for a examination within 60 days after adoption. *

I understand and acknowledge that The Humane Society of Lebanon County does not guarantee the health nor the temperament of any animal in its facility. I hereby release the Humane Society of Lebanon County from any liabilities I may incur from this adoption process or from the subsequent ownership of this dog. *

Signature: *

By typing your name in the signature box and clicking Submit, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.