Humane Society of Loudoun County, VA
- Adoption Application -

Note to applicants (please read before filling out the adoption application):

  1. Humane Society of Loudoun County (HSLC) reserves the right to refuse placement of any animal. The animal's well being and safety come first.
  2. The application, is just an application, and does not guarantee that an adoption will occur.
  3. The HSLC application review committee must approve this application.
  4. Placement process may take up to 2 weeks.
  5. There may be other applications on the animal you are applying for.
  6. This animal is under the sole custody of HSLC. Any questions regarding this animal, please call: 703-777-2912 or send an email to HSLCVA@humanesocietyofloudouncounty.org

The purpose of our adoption programis to find responsible, liflong homes for animals suitable as family pets.If you are interested in adopting an animal, please complete this.application (there is also the possibility to download the application form (pdf format) , fill out and bring it to the next adoption day):

Adoption Application Form
(Applicants must be over the age of 18 to send this adoption application and contract.)
Note: adoption fees: Cat/Kittens $85.00 Dogs $150.00
Name of animal(s) interested in adopting:
Name:
Address:
City: State: Zip:
Day phone: Evening phone: Other phone:
Email:

Which best describes your home: House Townhouse condo Apartment Mobil Home
I live with my parents

Do you own rent? Landlord’s Name, Address & Phone:
If you rent: I do have the landlord’s written permission to adopt this (these) animal(s).

List two local references (not family members) Name, Address, Daytime-Phone:
Why do you want to adopt this (these) animal(s)? (please check all that apply)
Companion Mouser Gift To breed Child's pet
How many children in family? , Ages:
Who will be responsible for the pet(s)?
Have you ever adopted a pet from us? No Yes. if so, when?
Do you understand this animal MUST be spayed or neutered, if not already? No Yes.
Will this pet be INDOORS or OUTDOORS .
Are you planning to declaw this pet (applies to cats only)? No Yes.
Do you own pets now? No Yes. Are they vaccinated? No Yes
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Type Sex Age Name Neutered/Spayed Where is the pet now
Name & Phone # of your veterinarian:
Have you ever brought animals to us? No Yes. If so, when?

Pets require wholesome food, fresh water, vet care, proper shelter, medications, vaccinations, licenses, and grooming aids. Did you know it normally costs $316 -$624 to care for a cat and $346 - $1,021 to care for a dog the first year you own the adopted pet? No Yes

Are you financially prepared to provide this care and commitment? No Yes
Are other family members aware that you are considering adoting a pet? No Yes
Are you willing to provide the animal with a lifelong home? No Yes
If, at any time, you are unable to keep this pet, do you understand that you must return it to the Humane Society of Loudoun County? No Yes
Do you understand that the Humane Society of Loudoun County makes no representations or guarantees about any animal's temperament, and that any comment that an animal is good with children or other animals, or is housebroken, is based upon information provided by the previous owner and is believed to be true. The Humane Society of Loudoun County is not liable for any future injury or damage which may be caused by this animal. No Yes
HAVE YOU EVER BEEN CONVICTED OF ANIMAL CRUELTY, ABANDONMENT OR NEGLECT. No Yes

If you did not find the pet you want, please fill in the information below and let us know what you would like:
Dog Puppy Cat Kitten Bird Bunny other:
Male Female   Breed: , up to what age:
long hair short hair   color:

remarks:

Thank you for your great help and big loving heart !

  © HSLC