CHA Adoption Application

First Name Last Name

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Savings Support from co-applicant/family/friends Pension/Retirement Benefits Expected employment in near future Other

First Name Last Name

Yes No, I am the only adult who lives in or frequently visits the home

First Name Last Name

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

House Apartment Townhouse Mobile Home Condo Other

Breed Restrictions Animal Weight Limit Number of Pets Limit (such as no more than 2, etc.) Additional Pet Deposit Fee Does Not Allow Pets No Restrictions

Allergy: Divorce: Moving: New Baby: Biting: Current Pet(s) Not Adjusting: Other

Cat/Kitten Dog/Puppy

Fenced Yard Run Loose Invisible Fence Kennel Leash Tie Out Other

I understand and will likely bring my dog(s) I understand but will likely be unable to bring my dog(s) I do not have any other dogs

Yes (Please fill out information below) No

Name:
Breed:
Age:   year(s)
Spayed/Neutered:   Yes   No
Where Housed?:
Where is pet now?:

Name:
Breed:
Age: year(s)
Spayed/Neutered:   Yes   No
Where Housed?:
Where is pet now?:

Name:
Breed:
Age:   year(s)
Spayed/Neutered:   Yes   No
Where Housed?:
Where is pet now?:

First Name Last Name

NOTE: CHA Animal Shelter is unable to accommodate any type of “hold” for any animal. Interested adopters can fill out and submit an application to remain on file for convenience but filling out an adoption application does not guarantee that a person will be first for a specific animal in any situation.

Adoption Application

If Interested In Adopting A Dog:

If Interested In Adopting A Cat:

Pet History

OPTIONAL: