Canine Healing Project Adoption Application
Are you interested in a particular dog? If so, which one.
Your Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
How long have you lived in your current home?
Do you rent or own?
If rent, can you provide Landlord name, address, and phone #
Do you have permission from your landlord to have a dog?
Are you aware of pet deposit fee or monthly fees if required?
Do you have a fenced yard? If so what type of fence and how high?
If you do not have a fenced yard are you prepared to walk your dog multiple times per day?
What is your family lifestyle like? Choose all that apply
active and on the go
quiet and relaxed
entertain frequently
lots of kids in and out
travel frequently
Do you have children
Yes
No
in the future
If you have children list names and ages
Why did you decide to get a dog?
What are you looking for in a dog?
Who will be responsible for taking care of the dog?
How many hours a day will the dog be alone?
Where will the dog stay when no one is home?
Where will the dog stay when you are home?
Where will the dog stay at night?
How will you exercise the dog and how often?
Who will care for your dog when you are out of town?
Under what conditions would you give up your dog?
Provide the following information about your current pets
Rows
Pets Name
Breed
Age
Spayed or Neutered
pet 1
pet 2
pet 3
pet 4
pet 5
Provide information on any pets you have had in last 5 years and why they are no longer with you:
Are you familiar with our therapy dog program?
*
Yes
No
Have you ever done therapy dog work?
*
Yes
No
If you are applying for a dog that we deem to be fit as a therapy dog, would you be interested in becoming a certified therapy dog team and make visits to local hospitals, senior living, schools, universities, etc?
*
Yes
No
Maybe
Current vet name and phone number:
*
By submitting this application I agree that I am prepared for a 10-15 year or more commitment to my dog. I will keep my dog on a regular routine of heartworm preventative and flea and tick control. I will work with my vet and agree on a regular schedule for wellness visits, inoculations, and any test necessary for the health and well being of my dog. I will not chain or tie up my dog outside. My dog will be an indoor dog and an important member of my family. If for any reason I am unable or unwilling to care for this dog, I agree to return him/her to Canine Healing Project. I will not give this dog away, take it to the shelter, place him/her with another person or family member, nor sell this dog to any person. I am financially able to provide routine and emergency care for this dog for his/her lifetime. This includes but is not limited to food, boarding, regular vet care, heartworm preventative and flea and tick preventative. I understand adoption fees range from $150 to $500 depending on the level of training the dog has received.
*
Submit
Should be Empty: