CCRT DOG ADOPTION APPLICATION
Thank you for your interest in adopting. Please be patient as I am only one person. If you are approved you are approved to adopt through CCRT not approved directly for the animal in your application. You will be matched with the best fit. YOU WILL RECEIVE A TEXT MESSAGE TO THE NUMBER YOU PROVIDED ONCE YOUR APPLICATION HAS BEEN RECEIVED (WITHIN ONE WEEK OF SUBMISSION)
Name(s) of animal(s) you may be interested in:
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If wanting to be pre-approved for future animals please type "pre-approval"
Name
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First Name
Last Name
Age:
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Name of co applicant:
First Name
Last Name
Age of co applicant:
Driver's license number:
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Email
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example@example.com We will NOT send you any emails, this is for paperwork purposes
Applicants workplace:
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Position:
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Phone number of workplace:
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Please enter a valid phone number.
Co applicants workplace:
Position:
Phone Number of workplace:
Please enter a valid phone number.
Most current veterinarian office:
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If new pet owner please put the information on the vet office you will use
Name records are under:
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First Name
Last Name
Vets Phone Number:
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Please enter a valid phone number.
Are you a first time pet owner?
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Yes
No
Do you currently have any pets?
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Yes
No
Please list NAME, AGE, and BREED of current pet(s)
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Please list NAME, AGE, and BREED of current pet(s)
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How long have you owned these pets?
Current on vaccines? If not please explain:
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Are your current pets spayed/neutered? If not please explain:
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Please list NAME, BREED and AGE of PAST pets and what happened to them:
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Please list NAME, BREED and AGE of PAST pets and what happened to them (why euthanized)
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How long did you own them?
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Where do your current pets stay during the day?
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Please be specific (crate, confined to certain area of home, free roaming, etc.)
During the night?
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Please be specific (crate, confined to certain area of home, free roaming, etc.)
Number of children in home:
Ages of children in home:
Do they live with you Full time or Part time?
Full time
Part time
Number of adults living in your home:
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Will anyone be home during the day?
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Yes
No
Who has main responsibility of adoptive animal?
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What do you consider the location of your home to be?
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Suburban
Urban
Rural
Type of home?
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House
Apartment
Townhouse
Condo
Other
If selected "OTHER" please describe:
Do you rent or own?
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Rent
Own
If you rent please provide landlords first and last name and number
How would you describe the energy level in your home?
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Calm/quiet
Moderate
Active
Do you have a fenced yard?
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Yes
No
Not yet but will in the next 6 months
What type of fence do you have? How tall?
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If you plan on having a fence in the near future please tell us what type and height
If you do NOT have a fenced yard, please describe how you will provide proper exercise in detail:
Why did you choose adoption? Have you adopted before? If so please provide what organization you have adopted from and what year
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Most rescue animals have unknown pasts and can have issues that need to be worked out. Are you willing to do whatever is needed to help them become a better family member?
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If issues arise are you willing to work with a trainer?
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If you do not have a trainer connection please let us connect you with our partnering trainer
If you are interested in one of our shy/fearful dogs please explain in detail your experience with dogs who are fearful/timid
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Please type N/A if not applying for a shy/fearful dog
Where will your adopted pet be kept most of the time?
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Indoors
Outdoors
Indoors/outdoors
Typically how many hours will your pet be left alone?
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When the animal will be home alone, where will he or she be staying?
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Free movement of home
Crated (until able to be trusted)
Confined (in room until able to be trusted)
Crated
Confined to one area of home
Outdoors
Garage
Animals are a lifelong commitment. Are you prepared to care and love this pet for 15+ years?
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How will you provide proper exercise and stimulation for your adopted dog?
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Please be specific
Have you ever given up a pet before?
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Yes
No
If selected YES above, where did that pet go?
Friends
Family
501c3 organization
SPCA
Animal Control
Rehomed on Facebook
Rehomed on Craigslist
Other
What was the reason for giving up that animal?
What was the reason for giving up that animal? What year?
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What type of behavior problems would cause you to surrender the animal back to us?
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Excessive barking
Chewing
Scratching
Housebreaking
Shedding
Digging
Does not get along with other pets
None
Other
If selected "OTHER" Please describe:
To help resolve issues, are you willing to crate or crate train?
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Yes
No
Attend training courses?
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Yes
No
What will you do with your animal if traveling or going on vacation?
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Bring with me
Board at boarding facility
Board at vets office
Hire a friend or family member to stay home
Animal will go to friend or families home
Hire pet sitter
Other
If you selected "OTHER" please explain:
Do you travel often? If so how many times a year approximately?
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What will you do with your animal if you move?
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Under what possible circumstance would you give up your animal?
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Move
New baby
New pet
Divorce
Personal illness
High cost of animals care
None
Other
If selected "OTHER" Please explain:
Are you aware you may NOT have any cosmetic procedures done on the animal
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Yes
No
Please provide 2 personal references (no family members)
Please make these references aware we will be giving them a call/sending text message before submitting application
Name of 1st reference:
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First Name
Last Name
Phone Number of 1st reference:
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Please enter a valid phone number.
Name of 2nd reference:
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First Name
Last Name
Phone Number of 2nd reference:
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Please enter a valid phone number.
If I am approved to adopt from CCRT I agree to take the animal to a full service vet of my choice WITHIN 30 DAYS of adoption for a wellness visit at MY cost and send CCRT proof of visit. Vaccine clinic locations are not approved, this must be a vet who has regular clients, takes appointments, sick appointments, etc.
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Individuals who adopt from CCRT are contacted periodically for an update to ensure the animal successfully adjusts to its new home. Do you consent to provide updates?
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If at ANY time the adopter cannot keep the animal, it is REQUIRED the animal be returned to CCRT care
We require current animals in the household to be altered
If pet has medical issue preventing spay or neuter you can still be considered
I understand CCRT is a one person operation, I will be considerate and kind. If I am unkind/rude my application may not be screened and adoption from CCRT may be declined
By signing below, I knowledge that I have answered every question honestly and have understood every question. I understand applying does not ensure approval and untruthful answers or failure to comply with the requirements of this application or adoption contract can result in forfeiture of the adopted animal
Signature:
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Date
*
-
Month
-
Day
Year
Date
I certify that I have not (nor no one in my home) has ever been convicted of animal related charges including animals at large, cruelty, neglect, etc.
Signature
*
Date
*
-
Month
-
Day
Year
Date
CCRT reserves the right to refuse or deny any application
When application is submitted please allow up to 5 business days to hear from Emma.
You are more than welcome to text Emma at 757-675-3662 for an application update
CCRT OFFICE USE ONLY
Please do NOT fill out
Home check:
Approved
Denied
Date of home check
-
Month
-
Day
Year
Date
Vet check
Approved
Denied
Date of vet check
-
Month
-
Day
Year
Date
Reference calls
Approved
Denied
Application Status
No answer from potential adopter
Potential adopter has declined to continue
Approved
Denied
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