Dog Application

Adoption Prerequisites
- NOTE: You must fill out every field with a star by it or your application will not be submitted.
Date*
MM slash DD slash YYYY
Dog Name*
Applicant 1 Name*
First Last
Applicant 2 Name
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Home Phone*
Cell Phone
Work Phone
Renters
Please provide your landlord's contact information
Landlord Name or Complex Name
First Last
Landlord Phone
What county do you live in?*
I give CCHS permission to check my references
- Yes
I want my dog to be*
- Inside
- Outside
- Inside/outside
My experience with dogs includes:*
- Had a dog(s) growing up
- Currently own a dog
- This will be my first dog
My dog needs to be good with children*
- All aged children in my home
- Children under 7 in my home
- Children over 7 in my home
- No children in the home but children visit
- No children in the home
When I am gone, my dog will be*
- In a crate
- loose in the home
- confined to a room
- outside-contained
- outside-loose
My new dog must get along with
- Other dogs
- Cats
- Livestock
- Horses
- Poultry
Please list the pets you have now or in the past.
Name Breed Age Gender Spayed/Neutered Current Vaccinations? Still own?
If a current pet is not spayed or neutered, please explain the reason.
CCHS HAS THE RIGHT TO ACCEPT OR DENY THIS APPLICATION FOR ANY REASON
We choose the home WE feel is the best home for the dog based on the interaction/application with the family and other dogs. A filled out application DOES NOT guarantee your application will be accepted for the dog you are applying for. Dogs will not be held without an approved application. I hereby state that information provided is true to the best of my knowledge. Falsifying information will result in a denial of my application. I also sign that I understand how the adoption process works and the fees involved with adoption. I understand that if the dog I have chosen is not altered at the time the application is filled out, I must wait until the surgery is performed before the dog can go home with me. Dogs will be held no more than 2 days after an application is approved.
Do you give CCHS permission to do background check on the information you have provided?*
- Yes
- No
Signature*

By signing, I certify that the information I have given is true, and I realize that any misrepresentation of facts may result in loss of adoption privileges.

Name	Breed	Age	Gender	Spayed/Neutered	Current Vaccinations?	Still own?

Dog Application

Dog Application

Adoption Prerequisites

Renters

CCHS HAS THE RIGHT TO ACCEPT OR DENY THIS APPLICATION FOR ANY REASON