Cat and Small Animal Adoption Application I am interested in adopting a cat or small animal from Lake Humane Society*YesNoI am interested in adopting:*CatSmall AnimalIs there a specific animal you are interested in? If so, please provide their name(s)Name* First Last Driver's License #*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email I live in a:*HouseCondoApartmentMobile HomeOtherAt my current residence listed above, I:*OwnRentLive with Parents/GuardiansIf you do not own your home, please list the homeowner's name and phone:*What is the total number of people in your household?*Are they all present today?*YesNoHow many children (under 18) live in your home?*List their ages:My new pet will live:*Indoors OnlyIndoors/OutdoorsOutdoors OnlyOtherMy home environment is:*Very BusySome ActivityVery Calm and QuietOn average, how many hours will this pet be left home alone each day?*How often do you have guests/gatherings at your house?*What is your experience level?*First Time Pet ParentSome experienceVery experiencedI have experience with:*Small animalsMedium animalsLarge animalsNo dogsI want my pet's activity level to be:*HighMediumLowI want to adopt this pet for:*Myself/Someone else in my householdSomeone in another householdDo you own other pets?*YesNoPlease list the current pets residing in your homePet Species and BreedAge/SexLength of ownershipSpayed/NeuteredIndoor/Outdoor What veterinarian do your pets see?Vet Phone NumberAre your pets up-to-date on vaccinations? Date of last visit?What types of animals have your pets been exposed to?Are there any additional details you would like to share?Please check each box to demonstrate understanding of LHS adoption polices. If each box is not checked, your application will not be considered.* LHS reserves the right to deny any applicant for any reason LHS strongly recommends that all members of the household interact with the pet before adopting If you are interested in adopting a dog from LHS and you have another dog(s) in your residence, you are required to bring your dog(s) to the shelter for a Meet and Greet If you are misleading or untruthful in the information that you've provided on this application, you will be denied adoption of this animal and may be added to our do not adopt list Adoption fees and deposits are non-refundable under any circumstances I fully understand that completion of this application does not guarantee adoption Type your name in this box to confirm the information provided in this application is truthful and accurate.*