Online Adoption Application

* indicates a required field

2. Type of Pet
   -- Select One --Dog or puppyCat or kittenPocket Pet

   What type of pet are you interested in adopting?

3. Name of Pet you are interested in

   If you are applying to meet a specific animal that is currently available for adoption, please put their name here.

5. First Name
6. Last Name
8. Date of Birth
10. Physical Address
12. City
13. State
14. Zip Code
16. Mailing Address
18. City
19. State
20. Zip Code
22. Phone Number
23. Alternate Phone Number
25. Email Address
29. Rent or Own
    -- Select One --RentOwn

    Do you rent or own your home?

30. Landlord contact information

    Please provide contact information for your landlord if you rent your home.

34. Do you have any livestock living on the premises??
    -- Select One --YesNo
36. If you answered yes, please tell us about the livestock?

    Please tell us what types of livestock live on the premises.

40. Do you have any companion animals or pocket pets currently living in your household?
    -- Select One --YesNo

    If you answered yes, please tell us about your pets below.

42. Type of animal
    -- Select One --DogCatPocket Pet
43. Name
44. Sex and Reproductive status
    -- Select One --Intact FemaleIntact MaleSpayed FemaleNeutered Male

    Please choose the correct sex and reproductive status for this pet.

45. Indoor, outdoor, or both
    -- Select One --Indoor onlyOutdoor onlyBoth

    Please tell us if this pet lives indoors, outdoors, or both.

47. Type of animal
    -- Select One --DogCatPocket Pet(s)
48. Name
49. Sex and Reproductive status
    -- Select One --Intact FemaleIntact MaleSpayed FemaleNeutered Male

    Please choose the correct sex and reproductive status for this pet.

50. Indoor, outdoor, or both
    -- Select One --Indoors onlyOutdoors onlyBoth

    Please tell us if this pet lives indoors, outdoors, or both.

52. Type of animal
    -- Select One --DogCatPocket Pet
53. Name
54. Sex and Reproductive status
    -- Select One --Intact FemaleIntact MaleSpayed FemaleNeutered Male

    Please choose the correct sex and reproductive status for this pet.

55. Indoor, outdoor, or both
    -- Select One --Indoors onlyOutdoors onlyBoth

    Please tell us if this pet lives indoors, outdoors, or both.

57. Type of animal
    -- Select One --DogCatPocket Pet
58. Name
59. Sex and Reproductive status
    -- Select One --Intact FemaleIntact MaleSpayed FemaleNeutered Male

    Please choose the correct sex and reproductive status for this pet.

60. Indoor, outdoor, or both
    -- Select One --Indoors onlyOutdoors onlyBoth

    Please tell us if this pet lives indoors, outdoors, or both.

62. Type of animal
    -- Select One --DogCatPocket Pet
63. Name
64. Sex and Reproductive status
    -- Select One --Intact FemaleIntact MaleSpayed FemaleNeutered Male

    Please choose the correct sex and reproductive status for this pet.

65. Indoor, outdoor, or both
    -- Select One --Indoor onlyOutdoor onlyBoth

    Please tell us if this pet lives indoors, outdoors, or both.

67. Type of animal
    -- Select One --DogCatPocket Pet
68. Name
69. Sex and Reproductive status
    -- Select One --Intact FemaleIntact MaleSpayed FemaleNeutered Male

    Please choose the correct sex and reproductive status for this pet.

70. Indoor, outdoor, or both
    -- Select One --Indoors onlyOutdoors onlyBoth

    Please tell us if this pet lives indoors, outdoors, or both.

72. More than 6 pets in your household?

    Please include the types, names, sex and reproductive status, and living situation (indoor, outdoor, or both) for any additional pets in the household here.

74. I certify that the above information is true.  I also understand that giving false information on this application is grounds for denying my application.  This application remains the property of the Lincoln County Animal Shelter.

    Lincoln County Animal Shelter reserves the right to refuse adoption to anyone without disclosing the reasons.  Completion of this application does not guarantee adoption of an animal.

76. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
78. Electronic Signature
Leave This Blank:


79. 1. Receive an email copy of this form.
80. Email address

    This field is not part of the form submission.

81. Submit