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Contact Information

If you are interested in adopting an animal from the Animal Shelter please fill out and submit this application. Questions? Email Wayne Marshall, or call the shelter at 706-867-7297.
First Name*
Last Name*
Street Address*
Address Line 2
City*
State*
ZIP Code*
Phone*
Email*
Website
Are you over 18 years of age?
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Employment & Residential Information

Place of Employment
Do you own your home?
If not, are you allowed to have pets?
Property Owner Name
Property Owner Phone
How long have you lived at this address?
Are you planning on moving the next 6 months?
How many adults, other than you, will be living in the home?
How many children?
Age of Children
1. Under 1
2. 1 to 3
3. 4 to 7
4. 8 to 13
5. 14 to 17
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Pet History

Have you had pets before?
What kinds of pets?
How many dogs and cats currently live in your home or on your property?
Are these animals spayed or neutered?
Are these animals current on their rabies shots?
Your Veterinarian's Name
Veterinarian Phone
Have you ever been charged with cruelty to animals or humans?
Have you every been charged with animal abandonment?
Have you every given up an animal because you could not keep it?
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Animal Information & Arrangements

Animals Name Used at Shelter
Animal Control Number at the Shelter
Additional Information About Animal at the Shelter
Where will this animal live?
What kind of outside shelter will the animal have for both hot and cold weather?
Who will be responsible for the veterinary costs for this animal?
Who will be responsible for the daily care and feeding of this animal?
How will you keep your pet confined to your property?
Are you willing to have Animal Control or a representative of the humane society visit your home to assure this animal is being cared for properly?
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Agreements

- I (we) will not use the animal for experimentation or for vivisection
- I (we) will not allow the animal to roam
- If I (we) can no longer keep the animal, I (we) agree to find the animal a good home
- I agree to allow Lumpkin County Animal Control to investigate my home and remove the animal if the animal is not properly cared for
- I (we) understand that the Lumkpin Co. Animal Shelter does not have a veterinarian on staff and that the animal is received by me without warrant as to health, disposition, or anything else about the animal. I (we) understand that the animal has not had a health exam and has had no shots, baths, medication, or treatment of any type. I (we) agree to take the animal as it is
- I (we) agree to take the animal to a veterinarian to have rabies shots as prescribed by law and to see that the animal has all necessary shots and to care for the animal as prescribed by a veterinarian
- I (we) agree to have the animal sterilized within 30 days of adoption
- I (we) agree to bring to the Lumpkin Co. Animal Shelter proof from the veterinarian that the animal has been sterilized and given rabies shots
- I (we) understand that having the animal sterilized is a state law and that if I do not bring back proof of sterilization to the Lumpkin Co. Animal Shelter as stated above that a Lumpkin County deputy will visit my home or place of work and I may be charged
- I (we) agree to pay for all costs associated with sterilization, shots, health, and maintenance of the animal
- I (we) understand that the Lumpkin County Animal Shelter does not have a refund policy and that no monies can be refunded
- I (we) agree to hold harmless the Lumpkin County Animal Shelter, Animal Control, the Lumpkin County Sheriff’s Office, for any illness the animal may have or cause and for any damage or aggression or problems the animal may cause or for any expense or other problems caused or incurred by this animal
I certify the above information is accurate and complete to the best of my knowledge. I understand that the Lumpkin County Animal Shelter, Animal Control, has the right to reclaim the animal if any information given is false or inaccurate, if the animal is not properly cared for, or if the animal is not sterilized according to the adoption agreement. I authorize the release of any information related to my ability to lovingly care for pets.
Photo Identification

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

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