Please provide a veterinarian reference:
Name of clinic: _______________________________________________ Phone number: _________________________
All names your records may be under: ____________________________________________________________
List one personal reference:
Name: __________________________________________ Phone number: ____________________
I give CCHS permission to check my references:
Signature: ______________________________________________ Date: _____________________

Are you willing to commit to owning a dog for the next 10-12 years? YES    NO    UNDECIDED
How did you hear about this animal shelter: __________________________________________________________
Describe a typical day in your household: ____________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________
Is your residence a: HOUSE  TOWNHOUSE    CONDO     FARM    APARTMENT    MOBILE HOME
Do you have a fenced in yard?  ________________ How tall is the fence? _________________
How large is the fenced in area? ________________________________________________
If you do not have a fenced in yard, how will you contain your dog when its outside?: _____________________________
How do you plan to meet the exercise needs of this dog? _________________________________________________
How many hours will the dog be left alone per day?  _________________
How will you keep the dog happy and content while you are gone? ________________________
Where will you keep this dog?  INSIDE    OUTSIDE ONLY     INSIDE/OUTSIDE
If you want to have an outside dog how will you control excessive barking? ______________________________________
Boredom when left alone? ________________________________________________________________________
What type of housing will you provide your outside dog? __________________________________________________
How will you contain your dog outside:    CHAIN    KENNEL    RUN LINE

Most shelter dogs and puppies have unknown housetraining history. How do you plan to housetrain?
_____________________________________________________________________________________________________
How soon do you expect this dog to housetrain? __________________  If it takes longer than you expect, what will you do? _________________________________________________________
If you prefer not to crate train, how will you control chewing, potty breaks and mischievous behavior?
_____________________________________________________________________________________________________
*Crate training your new dog will keep them out of trouble. If you need information on crate training, please ask a staff member for advice or do research.
 
What is your definition of disciplining a dog? _________________________________________________________
Please describe the needs of the breed you have chosen:______________________________
_____________________________________________________________________________________________________
If you are unfamiliar with the breed you have chosen, you should research the breed. This can be done by
talking to a staff member, reading books or searching the internet. Will you do the research necessary to
make you familiar with the breed?_______________________________
 
If your lifestyle changes will the change include the dog? _____________________________  What will you do with the dog if you are having trouble adjusting to the lifestyle change with the dog? _________________________________________
It may take 1 month or longer for your new dog to adjust to your lifestyle and your routine. Will you allow this much time for adjustment? ________________________
If your new dog has problems adjusting to your home, what do you plan to do to help your dog adjust? _____________________________________________
If your dog became seriously ill, would you be able to care for it financially? _____________________If not, what will you do to ensure the dog will be taken care of?_____________________________________________________________
Will you be attending obedience classes? ________________________ If not, please explain why?
_____________________________________________________________________________________________________
 
This dog has been vaccinated and cared for by CCHS. Will you take this dog for an exam within 7 days of adoption? _______________________ CCHS only gives a 7-day health guarantee. If you should not choose to take your dog to the vet within 7 days, please sign here: ________________________________________

I understand that if I have other dogs at home it is required that they come to interact with the dog I wish to adopt.           Initial here:__________
Have you ever surrendered a pet to a shelter/rescue group before? _____________________
Reason:_____________________________________________________________________________________
Have you ever given up a pet to someone other than a shelter or rescue group?_______________
Reason:_____________________________________________________________________________________
 
Please list the ages of the children in your household or those that will visit regularly: _______________________________
What are your plans for adjusting the new dog to the children in the household?
__________________________________________________________________________________________
Will you show your children and children that visit the proper handling of a dog? ______________
Do you have a quiet accessible area for food and water dishes away from the children? ______________
Do you have an area that is quiet for the dog to get away from the activity of the household? ______________
 
I understand that once I leave the shelter with my new dog, I am responsible for any damage or bites that are
caused by my new dog. Please sign here: ___________________________
Should you adopt a dog that isn’t working out and fitting in with your family, you will call CCHS for advice
or before giving the dog away or surrendering to another shelter. Please sign here: ___________________________
A dog is a lifetime commitment and we hope that every effort is made to make your new relationship work.

Please provide the following information on your pets, past and present:
 
 Name                                      Breed                                          Age             Male/Female             Spay/Neuter          Still Own _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________
 
If your current pets are not spayed/neutered, please list the reasons why: ____________________________
_____________________________________________________________________________________________________

CCHS HAS THE RIGHT TO ACCEPT OR DENY THIS APPLICATION. We choose the home we feel is the best home for the dog, based on interaction withe the family and other dogs.