Today's Date =
Name of pet(s) applying for (List in order of preference)
GENERAL FAMILY INFO
Your Name =
Place of employment =
Drivers License =
Spouse (or significant
other) name =
Spouse place of employment =
Drivers License =
Full names of all other adults in the home and relationship to you =
Name and age of
children (full and part-time) =
Street Address =
City / State / Zip
Mailing Address (if different) =
Home Phone Number =
Alternate Phone #1 (list whose) =
Email address(es) =
A) Reason(s) for wanting a dog (for kids, hunt, herd, protection, obedience,
farm help, etc) =
B) Home is: Owned by me, Leased/Rented, Owned by parents =
C) Will this be an indoor or outdoor dog? =
D) When outside will dog be: in fenced yard
(list type and height), loose/boundary-trained, leashed, kenneled (list size) =
E) Where will
the dog be at night? =
F) Where will the dog be when you're not home? =
G) Will the dog be loose outside unattended? =
H) Describe exercise the pet will get
I) Why is this particular pet a good match for you? =
List the vet clinic(s)(and phone#) you'll use for this pet =
If renting, you must
bring written permission from your landlord or a copy of your rental agreement at the time of adoption.
Include for all cats and dogs in the format
Name / Breed / Age / Sex / neutered/spayed? / Yrs Owned / Where Acquired / Lives Indoors
Pet 1 =
Pet 2 =
Pet 3 =
Pet 4 =
Pet 5 =
PREVIOUS PETS IN PAST 10 YEARS
Include all cats and dogs in the format below:
Name / Breed / Age / Sex / neutered/spayed?
/ Yrs Owned / What happened to pet / How long ago / Indoors or Out
Pet 1 =
Pet 2 =
Pet 3 =
Pet 4 =
Add more lines if needed for Current and Previous Pets. Failure to mention any dog or cat will cost you the adoption!
MORE ABOUT YOU
Returns are hard on pets and the family, so
help us prevent them. To ensure this is a great match for you and your lifestyle, please tell us what you require in this
dog. Expect at least a 30 day "adjustment period" for any pet.
A) Must it be good with
strangers? (Not shy / Not Protective) =
B) Must it be good with dogs? =
Must it be good with cats? =
D) Must it be good with children? =
Must it be able to be loose unattended outside? =
F) Must it be potty trained within 30 days?
Have you carefully read our entire Adoption Process? =
approved, we require that you be able to pickup your new pet within one week. You must come during open hours. (Noon to 3
PM on Mon, Wed, Fri and Sat). Please pick a specific date =
will email you (generally done in the evenings) to setup a time to meet and adopt the pet. If you're unable to check
your email at night, let us know, otherwise please frequently check your email!
a moment to be sure all questions were answered completely. As stated in the rules, mark "n/a" if a line does not
apply. This is your one chance to impress us! The info you give us will make sure we're matching the right pet and right
family together for a happy ending! Do you realize applications we feel are not complete cannot be processed? =
IMPORTANT! -- If we find a perfect home for a particular pet, we may cut off any further
applications that have been started. You must sign/type your name below. In doing so, you are agreeing
you've read our entire process and are swearing that all information you entered is correct. You also realize that by
submitting your application, you are in no way guaranteed a pet. CCHS takes great pride in not just finding "a home",
but a great home for each of our special pets. Rarely do we deny an applicant, so if you miss out on a pet, please do not
think of yourself as being denied. With the pet's best interest in mind, as well as yours, we match people and pets
together for long-term relationships and we'll try to help you find a great companion soon! CCHS has the right to deny
any application, for any reason, at any time. =
Thank You For Considering One
of our Special Pets!!
WHAT TO BRING FOR ADOPTION
1-If renting, a copy of lease/landlord permission note when picking the pet up. Landlord signed permission note
must include ALL things listed below (mark with N/A if no restriction)
A - Your name, and rental
B - Number of pets allowed on property?
C - Maximum Size of
D - What breeds not allowed?
E - Is declawing a cat
F - Are pets allowed inside the home?
G - List any other
H - Printed AND Signed landlord's name (include date signed)
I - Landlord's contact phone number
2-Bring your drivers license
3-Cats must leave in a carrier, Dogs with a properly fitting leash/collar--NO EXCEPTIONS! (Shop in our store--all
profits go directly back to the animals!)
4-Out of county adoptions must be paid in cash. You
can use a major credit card but there is a $2 processing fee.
Cats / Kittens - $30.00 / (higher fee may apply to purebred cats)
Dogs / Puppies - $60.00
/ (higher fee may apply to small dogs and puppies)
FEE INCLUDES: De-worming, Distemper Vaccine,
Vet Check, Flea / Ear mite treatment Rabies vaccination (if old enough), blood test (age permitting) and the majority have
already been spayed or neutered! Dogs are tested for Heartworm, Lymes Disease, Anaplasmosis and Erlichiosis (age permitting).
Most pets have already received routine or extra medical treatment upon arrival to get them healthy for adoption. All pets
leaving CCHS are microchipped which includes a free ID tag! Temperament testing allows us to make notations of the animals'
personality and helps to find a compatible forever family. We provide an adoption kit including recommended reading (for
proper training, safety, and introduction of the new pet), coupons and a sample of food to start them off right. You'll
also receive a free 1 yr subscription to our newsletter, Great & Small. In return, all we ask for are updates and photos
to post on our walls!