First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Which animal are you interested in*
Choose an animal: 1Cat Not Listed 1Dog Not Listed Angelica Anubis Baloo Banofee Barn Cat Beatrix Belladonna - Must Apply in Person Belle Birdie Bishop Bolt Bunny Lea Christopher- Must Apply in Person Cindy Lou- Must Apply in Person Cioppino Dani - Must Apply in Person Daniel Eloise Fallout Fancy- Must Apply in Person Fritz Galaxy - Must Apply in Person Gracie Lou Grenadine Hamilton Honey Hugsy Josie Julian Kanga Ken King Little Lightnin Loki Maple Marge Mason Mickey Doyle Miley Cyrus Mink Night Night Nucky Oscar - Must Apply in Person Pablo Padmé - Must Apply in Person Peggy Pepe PJ Poppy and Pearl Prada Prissy Rena Ritzi Ruedee Sage- Must Apply in Person Shanti - Must Apply in Person Sunny Sweet Pea Tom Valentino Yasmine Yogi

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

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.

What traits are you looking for in a dog?

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 marked that you own your house please answer the following question. According to the PVA are you the owner of your property?

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

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.

Who in the household will care for the pet*

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

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

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

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.

Describe how you will train the pet*

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

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence*
Choose one: Chain Link Invisible N/A Privacy

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