Humane Society of West Louisiana reserves the right to refuse adoption to anyone. In order to be considered for adoption you must: Be 18 years of age or older Have the knowledge and consent of your landlord Be able and willing to spend the time and money necessary to provide training, medical treatment, support, and care of a pet Have a fenced-in yard or agree to walk on a leash at all times Provide past and current vet reference
Please fill out the application and submit if still interested.

Full Name:

Street Address:

City:

State: ZIP code:

Home phone (with area code):

Work phone (optional):

Cell phone (optional):

E-mail*:

*An email address must by used in order to process application.

If you are applying to adopt a specific animal, please enter the name of the animal here.

Do you presently own any pets?   YES    NO

If YES, list the name and kind for each pet

If you own dog(s), cat(s) are they all spayed/neutered?    YES    NO
If NO, why not:

Please provide us with a veterinary reference, their address and phone number. (Name and Address):

Have you owned pets in the past?   YES    NO
If YES, what kind of pet, and what happened to them.

Where do you live:    House    Apartment    Other
Do you have a completely fenced yard?    YES    NO
If YES,
         -- What type fence:    Chain Link    Wood    Other
         -- How high is the fence?
Do you own your home:    YES    NO
If NO,
         -- Do you have permission from your landlord to keep a dog?    YES    NO
         -- Deposit?           Weight Limit?    lbs.
         -- Name of Landlord:
Landlord's Phone:

Are there children presently living in the house?    YES    NO
If YES, What are their ages?

Our pets come from a variety of sources. Each is examined upon arrival and is provided with ordinary, or in some cases, extraordinary veterinary care. They are routinely monitored while awaiting adoption, but there is always a chance that an animal is incubating a disease without showing any clinical signs. Do you understand this?
YES    NO

All dogs must be kept indoors. When allowed outdoors, they must be in a secured, fenced yard or on a leash. No exceptions. Do you understand this?
YES    NO

In the event that an adoption does not work out, we will accept any returned animal for any reason. However, three(3) days after receiving the pet, your adoption fee becomes non-refundable for any reason. However, some circumstances will be reviewed. Do you understand this?
YES    NO
Any Comments?

The information provided in this application (in its entirety) is true to the best of my knowledge as of the date on this application.
I agree that submission of this form will constitute a legally signed document.

Enter your name here to "sign":
Date:

Full Name:
Street Address:
City:
State:	ZIP code:
Home phone (with area code):
Work phone (optional):
Cell phone (optional):
*E-mail:**