Are you interested in adopting a cat or dog?
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If you are interested in a particular animal, please list which one you would like to adopt.
Your Name
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First Name
Last Name
Phone
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(###)
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Email
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Address
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City
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State
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Zip
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County
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How long have you lived at your current address?
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Do you rent or own?
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If renting, please provide the name of your landlord and their telephone number
Type of residence
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Number of square feet
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Do you have a fenced backyard? (dog applicants only)
Please provide the names and ages of residents in the household
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Do you currently have animals in the household?
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Please provide the names, ages and types of pets in the household
Please provide your veterinarian's name and phone number
Are your pets current on their vaccines?
Are your pets in altered? (spayed/neutered)
Are the pets in your household on heartworm and flea prevention? If so, what kind?
What food do your pets eat?
If you have owned pets in the past, what happened to them? (i.e. died from old age, cancer, euthanasia, gave away, accident)
Please provide the name, relationship, and telephone number of a reference NOT related to you
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Please provide the name, relationship, and telephone number of a second reference NOT related to you
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Please provide your employer's name, address, telephone number, your position, and the length of time you have been there (if you are a student please provide which school you attend)
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Where will your new pet live?
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How many hours a day will your new pet spend alone?
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Please explain how you will introduce your new pet to animals already in your home
What are your expectations of this animal? (We do not want you to adopt an animal with unrealistic expectations)
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What plans do you have to ensure your new pet will get enough exercise?
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What food do you plan to feed your new pet?
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In the next two years do you anticipate any major events in your life (moving, child birth, etc)? If so, explain how you would accommodate your new pet.
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I CERTIFY THAT THE INFORMATION I HAVE PROVIDED ON THIS FORM IS ACCURATE TO THE BEST OF MY KNOWLEDGE. I CERTIFY THAT I AM THE PERSON WHO WILL ADOPT AND CARE FOR THIS PET, IF APPROVED. I UNDERSTAND THAT ANY FALSE STATEMENTS CONSTITUTE GROUNDS FOR REFUSAL OF ADOPTION AND THAT CVRS HAS THE RIGHT TO REFUSE THE ADOPTION FOR ANY OR NO REASON.
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Signature of Adoption Applicant
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