Lakes Region New Hampshire (NH)
Humane Society
ADOPTION APPLICATION

 LRHS logo
Thank you for considering adopting a pet from our shelter. Please understand that we cannot guarantee the health of any animal or be responsible for any expenses incurred by the adopter. AS A POTENTIAL ADOPTER, PLEASE BE AWARE THAT MOST OF THE ANIMALS THAT ARE UP FOR ADOPTION WILL NEED AN ABUNDANCE OF PATIENCE, UNDERSTANDING, TIME AND TRAINING TO MAKE THEM AGREEABLE COMPANIONS.

In order to be considered as an adopter, you must:
1. Be 18 years of age or older.
2. Have identification showing your present address.
3. Have the knowledge and consent of the homeowner or landlord.
4. Understand that all fees are non-refundable.
5. Understand that this application is the property of LRHS and will be retained in our file.
6. Have all of your current animals up-to-date on required shots (distemper, rabies, etc.).
7. Understand that failure to answer any questions completely and precisely may result in a delay or refusal of your application.
8. Understand that LRHS has the full authority to approve, delay or deny your application. We hope that you understand that the animal’s welfare must be our primary consideration.
9. Agree to a home visit prior to adoption if LRHS feels this is necessary.

Please understand that this transaction is NOT A PURCHASE, IT IS AN ADOPTION. Therefore, LRHS can and will monitor the care of our animals received and LRHS MAY RECLAIM THE ANIMAL AT ANY TIME if the adopter fails to provide the animal with the care we have specified in the adoption contract.

To adopt an animal from LRHS, an adoption application must first be approved by a shelter representative.

Please complete the application thoroughly to avoid delays in the adoption process.

ADOPTION FEE SCHEDULE
 
Felines:
  • Kittens (< 1 year): $125
  • Adults (1 - 7 years): $85
  • Seniors (7 - 10 years): $65
  • Super Seniors (10+ years): $35

Canines:
Includes microchip
  • Puppies (< 1 year): $180
  • Adults (1 - 7 years): $130
  • Seniors (7 - 10years): $100
  • Super Seniors (10+ years): $55
Cardboard cat carrier $5 (Optional)
Micro chipping $30 (Optional)
Spay/Neuter Deposit: $40.00
Transfer Fee: $50.00 (subject to change)

First and Last Name(required)

Physical Address

Street
City
, 		 
 ZIP

Mailing Address

Check if mailing and physical address are the same

Street or P.O. Box
City
, 		 
 ZIP
Home Phone (required)
(xxx-xxx-xxxx) 		Business Phone
(xxx-xxx-xxxx)
Email (required)
 Driver's License #

Please answer the following questions thoroughly
in order to be considered an adoption candidate.

 

In which animal are you interested?
 
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What are your reasons for adopting a pet?
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For Children
For Protection
Companion
Mouser
Gift
Breeding

What sort of residence do you have?
Single Family Home
Apartment
Mobile Home On Private Lot
Mobile Home In a Park

Do you own or rent?    own    rent
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If you rent, landlord's name landlord's telephone
    (xxx-xxx-xxxx)

How long have you lived at this residence?

Do you plan on moving soon?    yes    no

What will happen to your pet(s) if you move or divorce?

Are you employed?    Full-time    Part-time    Not Employed
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If employed, employer's name employer's telephone
    (xxx-xxx-xxxx)
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If there is another adult in the household,   
He/she is:    Employed    Not Employed

Does anyone in the household suffer from allergies?    yes    no

Name and Age of all persons living in your household
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Name 1 Age
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Name 2 Age
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Name 3 Age
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Name 4 Age
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Name 5 Age
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Name 6 Age
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Name 7 Age
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Name 8 Age
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Name 9 Age
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Name 10 Age

What pets have you owned in the past seven years?
Where are they now?

List the names and species of the pets that reside with you now:
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Pet Name 1 Species
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Pet Name 2 Species
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Pet Name 3 Species
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Pet Name 4 Species
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Pet Name 5 Species
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Pet Name 6 Species

Have you ever adopted from LRHS?    yes    no
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If yes, give the adoption date: / /
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The name of animal at time of adoption:

Have you ever surrendered an animal
to any facility, and why?   

It may take 2 - 6 months for a new pet to adapt.
Are you willing to devote this time?		 yes no    
Are your current pets spayed/neutered? yes no n/a
Have your current dogs been tested for heartworm
and placed on heartworm preventative?		 yes no n/a
Have your current cats been tested for leukemia? yes no n/a
Have your current cats been tested for AIDS? yes no n/a
Do your current pets have up-to-date distemper vaccinations? yes no n/a
Do your current pets have up-to-date rabies vaccinations? yes no n/a
Name of Veterinarian
Is there another name that your vet records would be under? (example: maiden name)
Location of Practice Vet Phone
(xxx-xxx-xxxx)
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Is this the veterinarian you plan to use for your new pet? yes no n/a
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If no, please give name of veterinary office you plan to use:
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New Veterinarian
Location of Practice New Vet Phone
(xxx-xxx-xxxx)

Where will your new pet spend most of its time?
Yard Percentage of time to be spent there: %
Basement Percentage of time to be spent there: %
House Percentage of time to be spent there: %
Kennel Percentage of time to be spent there: %
 
Total Time = 100%

Do you have a fenced-in yard? yes no  

If you do not currently have or have not had any previous pets, in addition to giving us the name and number of your employer, please name two other references that are not related to you that we may call to help us determine your qualifications as a pet owner. A home visit may be required as well.
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Name of 1st Reference Telephone
(xxx-xxx-xxxx)
Name of 2nd Reference Telephone
(xxx-xxx-xxxx)


I understand that falsification of any of the above information is grounds for the immediate return of my adopted pet, or for the refusal of any adoption.

 

Sign on above line for mail and fax submissions
Date
If you are printing this form out to send it via U.S. Mail, please mark the envelope
ATTN: Adoption Counselor, and mail it to:

Lakes Region Humane Society
P.O. Box 655
Ossipee, NH 03864

If you don't hear from us within 2 or 3 days, please call to confirm that we have received your application.

Questions? Call LRHS at 603 539-1077.