Chelsea's Chariot Dog Adoption Application

Chelsea's Chariot Inc. Dog Adoption Application
Chelsea's Chariot is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Chelsea's Chariot is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.
This questionnaire is designed to help Chelsea's Chariot and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Chelsea's Chariot reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
Applicant Information
Name of the dog you are interested in: *
Your full name: *
Your age: *
Street Address: *
City, State, Zip *
Home Phone:

Area Code Phone Number
Work Phone:

Area Code Phone Number
Cell Phone:

Area Code Phone Number
E-mail:
Employer:
Character reference and phone number:
Household Information
Are all members of your household in agreement with this adoption? *

Yes No Don't Know
Who will be the pet's primary caregiver? *
Do you live in a *

House Apartment Condo Mobile Home
Do you own or rent? *

Own Rent
If rent, provide name and phone number of landlord:
Does your landlord allow dogs?

Yes No
Are there any restrictions from your landlord or subdivision? *

Number of pets Size or weight restrictions Breed restrictions None
Do you have a fully fenced yard? *

Yes No
Height and type of fence
Do you have any of the following?

Underground fence Kennel Dog Run
How many adults are in your household? *
How many children are in your household? *
If children, what are their ages?
Have your children been around animals before?

Yes No
Does anyone in your home have allergies to dogs or have asthma? *

Yes No
Current/Previous Pet Information
List any pets you own or have owned in the past five years, and their ages
How many of these pets are spayed/neutered?
Where are these animals now?
Have you adopted from an animal welfare group before?

Yes No
If yes, what group?
Have you ever given up a pet?

Yes No
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato) *
Are you aware of crate training? *

Yes No
Have you ever house-broken a dog or puppy before? *

Yes No
If the dog has an "accident" in your home, what type of correction do you plan to use? *
How many hours each day will your new pet be home alone? *
Where will your new pet sleep at night? *
How will you supervise the dog's outdoor activity? *
Where will your new dog stay when nobody is home? *
What length of time will you allow your new pet to adjust to his new home? *
Are you willing to work through your new pet's issues, if any? *

Yes No
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

Yes No
Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for? *

Yes No
Do you plan to take an obedience class with your dog? *

Yes No Not sure
If yes, where?
Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for? *

Yes No
What circumstances would lead you to give up your new dog? *
If you had to give up your dog, what would you do with him/her? *
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
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Chelsea's Chariot Inc. Dog Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information