EmailMe Form - Chap's Chow Rescue (CCR) Adoption Application

Name (pls note a red asterisk means an answer is required) *

First Last

Which dog are you applying for?

Date

MM / DD / YYYY

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Place of Employment

Your age?

This will help us determine the right dog for you.

Email *

Best Phone # for contact *

### - ### - ####

Name of co-applicant (if any)

First Last

Have you or anyone in the home ever been convicted of a felony? * *

If the answer is yes, please do not continue your application.

Where did you hear about Chap's Chow Rescue?

If you are out of state, how do you plan to pick up your new dog from us if you are approved to adopt?

Why do you want to adopt a dog? *

If you are renting, have you checked with your landlord or management to make sure this breed and size of dog is accepted - chow's are banned in many apartment complexes and rental situations.

Yes

No

What are the most important responsibilities of owning a dog? *

List any preferences

age, gender, color, personality, etc.

Do you have an application with another organization at this time? *

Yes

No

Which other organization(s) do you have an active application?

Have you ever been declined for an animal adoption from another organization? *

Yes

No

If your dog has an accident in the house, what would you do? *

If your dog growls at you, what would you do? *

How do you "correct" your dog when it does something undesireable? *

Describe the kinds of personal situations where you might have to return your adopted dog. *

Does any member of the family have any allergies to animals?

Yes

No

Does anyone smoke inside the home?

Yes

No

For whom are you adopting the dog? *

How many people live in your home? *

# adults & #children

What are the ages of the children living in your home? *

Who will be responsible for feeding and walking the dog? *

PETS YOU CURRENTLY OWN - Please list below

Pet 1 - name / type / age

gender / spayed or neutered

year obtained pet / where from

primarily indoor or outdoor, explain:

Pet 2- name / type / age

gender / spayed or neutered

year obtained pet / where from

primarily indoor or outdoor, explain:

Pet 3 - name / type / age

gender / spayed or neutered

year obtained pet / where from

primarily indoor or outdoor, explain:

Pet 4 - name / type / age

gender / spayed or neutered

year obtained pet / where from

primarily indoor or outdoor, explain:

Pet 5 - name / type / age

gender / spayed or neutered

year obtained pet / where from

primarily indoor or outdoor, explain:

Do you currently have more than 5 pets?

Pets listed below are no longer in the household (deceased or re-homed)

PETS YOU PREVIOUSLY OWNED IN THE LAST 5 YEARS- Please list below

Pet 1 - name / type / age

gender / spayed or neutered

year obtained pet / where from

primarily indoor or outdoor, explain:

year deceased or last had pet / cause of death or pet location now

Pet 2- name / type / age

gender / spayed or neutered

primarily indoor or outdoor, explain:

year obtained pet / where from

year deceased or last had pet / cause of death or pet location now

Pet 3 - name / type / age

gender / spayed or neutered

primarily indoor or outdoor, explain:

year obtained pet / where from

year deceased or last had pet / cause of death or pet location now

Have you had additional pets in the last 5 years that are NOT listed above?

Vet / Animal Hospital

name

street

city, state/province, zip/postal code

Name/s records are listed under

Please call your vet to give us permission to ask them questions about your pet's medical records.

Phone

### - ### - ####

Is this the Vet you will use for your newly adopted dog?

Yes

No

What type of home do you live in? *

House

Apartment/Condo

Townhouse

Do you rent or own? *

Rent

Own

If you rent:

Landlords name, phone #

How long have you lived at your current residence? *

Do you have a fenced yard? *

Yes

No

Type of fence

Wood

Chain Link

Other

If you do not have a fence, do you have plans to install one?

Yes

No

What brand of flea/tick preventative will you or do you use? *

What brand of heart worm preventative will you or do you use? *

What kind of food will you feed your dog? *

How will you groom your dog? *

Under what circumstances would you chain or tie-out your dog in the yard? *

Describe the circumstances in which you would walk/exercise a dog on-leash. *

Describe the circumstances in which you would walk/exercise a dog off-leash. *

How often will you exercise the dog and for how long? *

How many hours will the dog be left unattended? *

Saturday - Sunday / days off

Where will the dog be kept? *

when you are home

Where will the dog sleep? *

Do you have or plan to install a pet door? *

if yes, please provide details

How often do you travel? *

What will you do with the dog when you travel? *

What will you do with the dog if you relocate? *

Are you or your spouse a member of the military?

Yes

No

Are you aware of the Chap's Chow Rescue adoption fee?

Yes

No

Chap's Chow Rescue requires that all pets in the home are spayed or neutered, do you comply with this policy?

Yes

No

How much do you estimate it will cost to maintain the basic needs of caring for a dog? *

How many pets are you allowed to have in your home according to local county ordinances? *

Have all adult family members agreed upon adopting this dog?

Yes

No

References

Please provide 3 references that are not related to you

Reference 1 *

Name

*

Relationship

Phone *

### - ### - ####

Reference 2 *

Name

*

Relationship

Phone *

### - ### - ####

Reference 3 *

Name

*

Relationship

Phone *

### - ### - ####

TERMS OF SERVICE

I have read the above information carefully and have filled out this application honestly. If an omission or untruth is discovered after an adoption takes place, I understand that Chap's Chow Rescue reserves the right to annul the adoption and reclaim the animal. I give Chap's Chow Rescue permission to fully investigate the information provided as well as contact veterinarians and references. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a Chap's Chow Rescue volunteer before an adoption decision is made.

I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal. I understand it is Chap's Chow Rescue’s prerogative to decide which home is most appropriate and that their decision is final.

I have read and accept the terms of service.

Yes

No

PETS YOU CURRENTLY OWN - Please list below

***Pets listed below are no longer in the household (deceased or re-homed)***

PETS YOU PREVIOUSLY OWNED IN THE LAST 5 YEARS- Please list below

References

TERMS OF SERVICE

Pets listed below are no longer in the household (deceased or re-homed)