CHEW ANIMAL CLINIC - PET ADOPTION APPLICATION
Are you applying for:
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Please Select
FEMALE DOUBLE DOODLE
NAME
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First Name
Last Name
ARE YOU OVER 21 YEARS OF AGE?
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YES
NO
ADDRESS
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOW LONG AT THIS ADDRESS?
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2 VIDEOS REQUIRED 1) UPLOAD VIDEOS OF THE BACKYARD 2) WHERE THE DOG WILL SPEND MOST OF THEIR TIME INSIDE THE HOME
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Browse Files
Cancel
of
DAYTIME PHONE
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-
Area Code
Phone Number
EVENING PHONE
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-
Area Code
Phone Number
OWN YOUR HOME?
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RENT? (if yes, you must have landlord approval)
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IS YOUR YARD FENCED?
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YES
NO
Is a member of your household at home during the day?
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Yes - I work from home
No - I work out of the home
Yes - I am retired, or don't work
HOW WILL YOUR DOG BE EXERCISED?
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HOW OFTEN?
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WHERE WILL HE SPEND THE DAY?
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WHERE WILL HE SPEND THE NIGHT?
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HAVE YOU OWNED PETS IN THE PAST 3 YEARS?
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YES
NO
IF YES, WHAT HAPPENED TO THEM?
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WHAT ANIMALS DO YOU OWN NOW?
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ARE THEY SPAYED OR NEUTERED?
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YES
NO
IF NO, PLEASE EXPLAIN:
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IF YOU OWN OTHER DOGS OR CATS ARE THEY CURRENT ON VACCINATIONS?
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YES
NO
WHAT IS THE NAME & PHONE # OF YOUR VETERINARIAN?
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ARE THERE CHILDREN IN THE FAMILY?
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YES
NO
IF YES, WHAT ARE THEIR AGES?
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ARE YOU FINANCIALLY PREPARED TO PROVIDE THE NECESSARY CARE FOR YOUR PET: INCLUDING PROPER FOOD, VACCINATIONS, PARASITE CONTROL (FLEAS, TICKS, WORMS, ETC.) AND VETERINARY CARE FOR YEARLY CHECK-UPS AND MEDICAL EMERGENCIES?
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YES
NO
HAVE YOU EVER REHOMED YOUR PET?
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YES
NO
IF YES, WHAT WAS THE REASON?
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Initial: The adoption fee is $750 (donation made out to CHEW Animal Clinic). This Adoption fee covers: Exam, (3) DHPP, (2) Lepto (1) Bordetella (1) Rabies, Spay, microchip, fecal flotation, dewormer and (1) simperica trio, all to be done at CHEW.
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BY TYPING MY FULL NAME BELOW, I AFFIRM THAT ALL INFORMATION ABOVE IS TRUE.
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TYPE FULL NAME HERE
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