Columbus Lowndes Humane Society

50 Airline Road  •  Columbus, MS 39702  •  (662) 327-3107 phone  •  (662) 798-0063 fax  •  Find Us on Facebook

CLHS PRE-ADOPTION APPLICATION

This questionnaire MUST be completed before adopting a pet from our shelter. We are trying to place all of our animals in permanent, responsible homes and, at the same time, find the most suitable pet for you. By adopting you are giving permission for an authorized representative of the Columbus Lowndes Humane Society to visit your home for the purpose of inspecting your adopted pet and the premises where it is being kept.

Name:
Spouse Name:
Drivers License:
Address:
Cell:
-
Home:
-

EMPLOYER

Company Name:
How long employed:
Company Phone:
-
Pet for whom:
*If "Other", please specify:
Reason for pet:
If "Other", please specify:

RESIDENCE

Do you currently live in:
Do you currently own or rent:
Landlord Name:
Landlord Phone:
-
Are there children currently living in your home?:
If so, please list their ages:

CURRENT PETS

Do you currently have any pets at home?:
(a) Pet Name:
(a) Pet Type:
(a) *If "Other", please specify:
(b) Pet Name:
(b) Pet Type:
(b) *If "Other", please specify:
(c) Pet Name:
(c) Pet Type:
(c) *If "Other", please specify:
Please list any additional pets here. (Name, Pet type):
How are your current pets confined?:

PREVIOUS PETS

Please list other pets you have owned in the past five years and specify what happened to them:

Pet Name (a):
Pet Type (a):
Pet Age (a):
What happened to this pet? Be specific:
Pet Name (b):
Pet Type (b):
Pet Age (b):
What happened to this pet? Be specific: (b)
Pet Name (c):
Pet Type (c):
Pet Age (c):
What happened to this pet? Be specific: (c)

MISCELLANEOUS

Have you ever adopted from CLHS before?:
If yes, where is this animal now?:
Veterinarian Name:
Veterinarian Phone:
-
What type of heartworm prevention do you plan to use?:
What do you plan to do if the dog you adopt tests positive for heartworms?:
Where will this pet stay? If outside, describe yard/shelter.:
If you should move, what do you plan to do with your pet?:
Are you prepared to assume the financial responsibilities of caring for a pet?:

Including veterinary care, feeding, etc, the approximate annual costs for dogs is $250-$350 and for cats is $200-$300.

What are you interested in adopting?
Name of pet you are interested in:

The above information is true and correct to the best of my knowledge.

Applicant Name:
Date:

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Help CLHS Today!

Donate

Donate
The Columbus-Lowndes Humane Society has a contract with the City of Columbus and Lowndes County to provide Animal Care for unwanted or stray animals from the city. We are dependent for the remainder upon...
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Our Wish List

Our Wish List
Everyday Needs - Paper towels
- Anti-bacterial dish soap
- Large bath towels
- New heating pads
- Bleach
- Laundry detergent (any brand with bleach)
- Mr. Clean® Animal...
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Happy Tails: Make a difference!

Happy Tails: Make a difference!
Animal adoption does make a difference! When you adopt an animal from a shelter, you’re saving two lives, the life of the animal that you adopted and the life of the animal that’s going to take its...
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