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 Farm Animal Adoption Application
To help us make the best match for you and your family, please complete this form as accurately as possible.

Columbiana County Humane Society takes in abused, neglected, and abandoned animals; as well as those that are sometimes ordered removed by the courts.  We make every attempt to screen our animals for health, behavior, and temperament issues.  Certain types of problems may not demonstrate themselves until the animal is in a home environment.
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Email *
Date of Application *
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Type of Animal *
Animal Name (if applicable)
Name (First and Last) *
Address (including City, State, Zip) *
Phone Number *
Email Address *
Type of Residence *
Do you: *
If renting, landlord's name and contact information:
How long have you lived there? *
What do you do for a living? Please list your current employer? *
First time pet owner, as an adult? *
Do you currently have other pets? *
Number of adults (18 years or older) in the household and ages: *
Number of children (under 18 years old) in the household and ages: *
Please list any animals you currently live with OR have owned in the past three (3) years. Please format as: Name, Age, M/F, Breed, Spayed/Neutered, Still own? If not, why? *
Who is OR was your veterinarian (name and number, if available): *
Does anyone in your household have any allergies to animals? *
Describe the type of animal desired or interested in (breed, size, weight, long/short fur, gender, age, etc.) *
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