Adoption Application

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

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

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

The purpose of our adoption program is to find responsible, loving, forever homes for the animals in our care. If you are interested in adopting an animal, please complete the online Adoption Application form below.

You may also click HERE to download the .PDF version of our Adoption Application. To start the adoption process, please complete the form then mail it or bring it to the next adoption day event.

You can mail your application to HSLC at:

Humane Society of Loudoun County
P.O. Box 601
Leesburg, VA 20178

ONLINE ADOPTION APPLICATION

Name of animal(s) interested in adopting
First Name*
Last Name*
Address*
Apt#
City*
State
Zip
Country
Home phone
Work Phone
Email*
Which best describes your home	House Townhouse Condo Apartment Mobil Home
I live with my parents	Yes No
Do you?	Own Rent
If you rent please provide your Landlord's Name, Address & Phone
If you rent, do you have your landlord's written permission to adopt this animal?	Yes No
List two local references (not family members):
Name
Address
Daytime Phone #
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 and their ages:
Who will be responsible for the pet(s)?
Have you ever adopted 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 OUTDOORS
Are you planning to declaw this pet? (Cat adoptions only)	No Yes
Do you own pets now?
If so, Are they vaccinated?	Yes No
Please list all Please list below all pets you currently have, or have had in the past three years:. AGE, WHERE IS PET NOW?
Name & Phone # of your Veterinarian:
Have you ever brought animals to us?	No Yes
If Yes, when
Pets can be expensive (food, vet care, medications, vaccinations, etc.) Are you prepared to provide this care?	No Yes
Are you financially prepared to provide this care and commitment?	Yes No
Are other family members aware that you are considering adopting a pet?	No Yes
Are you willing to provide this animal with a lifelong home?	No Yes
If at any time you are unable to keep this pet, do you understand he/she must be returned to HSLC?	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. (Please initial)

I HAVE NEVER BEEN CONVICTED OF ANIMAL CRUELTY, NEGLECT OR ABANDONMENT. THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
Signature
Date
If you did not find the pet you want, please fill in the information below & let us know what you would like:*	Dog Puppy Cat Kitten Bird Bunny Other Male Female Long Hair Short Hair
Up to what age?
Breed
Color
Remarks (use back if necessary)

How You Can Help

There are many different ways for you and your family to help....
:. read more

Foster Application

Volunteer Opportunity

Spay/Neuter Program

Loudoun County residents pay a reduced fee to have their pet spayed/neutered when using a participating veterinarian...
:. read more

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