First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Once you submit your online form, you will be contacted after your application has been reviewed and approved by EMAIL and put in direct contact with the designated application counselor. Scott County Humane Society is located in Georgetown, Kentucky. We welcome local adopters and out of state adopters who are willing to come to Georgetown, Kentucky to pick up the adopted pet! Please be sure to check your email. I understand this policy.

Which animal are you interested in*
Choose an animal: 1Cat Not Listed 1Dog Not Listed Barn Cat Bonnie Bruiser Carter Catriona- Must Apply in Person Chocolate Clarence (PS) Duncan Frankie Gertie Gideon Hawkeye- Must Apply in Person Jane Fonda Jax Jelly- Must Apply in Person Jellybean Josie Kenyatta (PS) King Catnip- Must Apply in Person ! Lennox- Must Apply in Person Little Bear- Must Apply in Person ! Lulu Magnum Marigold Momma Mr. T Nala Okra - Must Apply in Person Pearl Perrin - Must Apply in Person Princess Queenie- Must Apply in Person Rogue Sage Salem Simba Soairse Stella Tabbi Tabitha- Must Apply in Person ! Tamala Wishbone

What traits are you looking for in a pet

If you are applying for 1 Cat or Dog Not Listed, what is the name of the animal you are interested in? If there is not a specific animal and you are looking for recommendations, please explain what you are looking for.

Do you own or rent your home*
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent/do not own your property, please enter your landlord/property owner's name and phone number

Age: (You must be at least 21.) *

Please list the age, gender and relation of others who reside in your household*

Do you anticipate any major changes to your household in the future such as a new baby, moving, marriage etc. If so, please explain.

Is anyone in your household allergic or asthmatic around pets?

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

Where will the animal be kept when you are not home*

How much time will the animal spend alone during the day*

For cats only: Are you planning to declaw?
Choose one: Yes No

For all pets living in your household please list the name, species, age, if spayed, neutered or intact, where kept (indoor/outdoor/both), and most recent vaccination date.

Have you ever given up a pet? If yes, please explain*

I certify that the information entered on this applicant is true. Enter your name and date*