CAN ADOPTION APPLICATION

Our goal is to place pets in permanent, loving homes. Please complete this application so we can assist you in finding a special, compatible companion to join your family. With this information, we can minimize the risk of a failed adoption. We do not adopt our dogs on a “first come, first served” basis, but rather try to match families to available dogs. The dogs are placed in permanent homes at our discretion. Companion Animal Network may refuse to adopt to anyone without providing a specific reason.

Our adoption fees help to defray the costs of spaying/neutering, testing and vaccinating our pets, treatment of parasites, any necessary surgeries, and heartworm treatments. These fees do not cover the expenses. Our animals are tested for parasites, heartworm tested and placed on heartworm preventative, and altered (if age appropriate).

Companion Animal Network recognizes the sensitive nature of the information in this application. Nothing in this application is shared with anyone. It is used to ensure the best possible home for our animals and is for our exclusive use for that purpose.

Note: Adopters must be a least 25 years of age to adopt.

Please review every question and type NA in the field if it doesn't apply to you.
YOUR NAME*
Please type your name
Date*

MonthDayYear
Today's Date
A rescued animal will have a period of adjustment which may be from two weeks to a few months.Are you willing to commit to this adjustment period and follow recommendations for a smooth transition?*

YesNo
Adoptee

Please type information about the pet in which you are interested
Name of animal in which you are interested*
Animal requested
Breed/Description*
Breed and/or description of pet
Male/Female*
Gender
Release for Veterinary Reference

(to be completed by potential adopter)
I hereby give permission for any veterinarian providing service to me to release all medical information for my current and prior animals to Companion Animal Network*
Please Type Name
(Signature)*

Clear
My current veterinarian is*
Name of current veterinarian
Veterinarian Location*
Veterinarian Phone Number*
Veterinarian phone number
If you do not have a veterinarian reference, please provide two personal references in the spaces at the end of the form.
If you have no vet now, what basis will you use for choosing one? (Examples: Referrals only, call and speak to the vet personally, ability to walk in, Fear Free)*
Basis for choosing a Veterinarian
What will constitute the need to see a vet? (Examples: an emergency, when they get sick, when shots are due)*
About You
Date of Birth*

MonthDayYear
Please enter your date of birth
Email*
Please enter your email
Please Enter Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone*
Please enter a valid phone number.
Home Phone*
Please enter a valid phone number.
Work Phone*
Employer*
What are your hours?*
Spouse/Partner’s Employer*
What are his/her hours?*
How many hours would the pet be alone while you and/or your spouse/partner are at work?*
Do you have a pet door?*

YesNo
Would you be willing to install one?*

YesNoOther
If “No”, how will you handle the dog’s elimination needs when you are not home?*
Where would the dog sleep?*
Have you housetrained a dog before?*

YesNo
If “Yes”, describe how you accomplished this*
Do you or your spouse/partner travel frequently?*

YesNo
If so, how often?*
What will you do with the pet when you travel?*
What will you do with this pet if you have to move?*
Are you willing/able to purchase and use a crate if needed or advised?*

YesNo
Have you heard of the term "socialization"?*

YesNo
Are you willing and able to expend the required amount of time and energy to “socialize” your dog, and to expose your dog to other dogs, people and children?*

YesNoOther
REQUIRED ANSWER - Dogs get heartworms from*
Please select the level of activity you consider yourself to have:*

very activemoderately activeseldom active
How would you exercise the dog?*
Does every adult in the household want this particular dog?*

YesNo
Does anyone in the household have allergies?*

YesNo
If yes, are allergies related to animal dander? *
Do you have children?*

YesNo
If yes, what ages are your children?*
If no, are you planning to start a family in the forseeable future?*
Do you have grandchildren?*

YesNo
If “Yes”, what ages?*
Do they live in the household?*

YesNo
If they do not live with you, how often do they visit?*
Your Home
Please check all options that apply to your home below:*

OwnRentHouseApartmentOther
If renting, how long have you lived at this location?*
If renting, does your lease allow pets?*

YesNo
Does your lease have breed or weight restrictions?*
Pet deposit required? (We require receipt for payment of pet deposit)*

YesNo
Rental manager’s name and phone number*
Do you have a fenced yard?*

YesNo
Please describe fence including height:*
Are your gates securely locked?*

YesNoOther
If no, are you willing to securely lock your gates?*

YesNo
Do you have a pool?*

YesNo
Is your pool area gated or otherwise separated from other parts of your yard?*

YesNoOther
Have you owned a rescued animal before?*

YesNo
Have you ever owned the breed/mix described in the beginning of this form?*

YesNoOther
Have you ever adopted from a rescue group or shelter?*

YesNo
If so, what group/shelter?*
Have you ever applied to adopt an animal and been declined?*

YesNo
If “Yes”, explain*
Have you ever given up animal(s)?*

YesNo
If so, why?*
What did you do with the animal(s)?*
Is there a limit on the amount you could or would spend on your dog if it became ill?*
How much is too much?*
Would you consider euthanizing your pet only because of medical costs?*
What qualities are you looking for in a pet? (Please be specific)*
What traits or characteristics are you sure you do NOT want?*
Do you give permission for a C.A.N. representative to visit your home prior to adoption to do a home visit and after adoption to do follow up visits?*

YesNo
Pet Ownership History
Do you or did you have other pets? Please state the breed, sex, etc. of each pet, including whether it was spayed or neutered, on heartworm preventative, how and when the pet was acquired, and why you no longer have the animal. If necessary, attach another sheet.
Name of Most Recent Pet*
Species*

dogcat
How acquired?*
Length of ownership*
Age of Animal*
Gender (check all that apply)*

malefemalespayedneutered
Heartworm preventative?*

YesNo
What kind of Heartworm preventative?*
Date of last shots: DHLPP Bordetella Rabies*

MonthDayYear
Date
Where did this animal sleep?*
Where did the pet stay while you were away or at work?*
Did this pet have any problems or medical conditions?*

YesNo
If “Yes”, explain*
What happened to this pet?*
My signature below affirms that the statements above are true and correct.
Signature*

Clear
Date*

MonthDayYear
Date
*PLEASE NOTE: THIS IS ONLY THE APPLICATION. IF AN ADOPTION IS PURSUED, A HOME VISIT WILL BE NECESSARY, AN ADOPTION CONTRACT MUST BE SIGNED, ALL REQUIREMENTS OF THAT CONTRACT MUST BE MET, AND THE ADOPTION FEE RECEIVED BEFORE AN ADOPTION IS CONSIDERED FINAL.
Personal References

Please include name and phone
Name
Relationship
How long known?
Phone No.
Address
Name
Relationship
Relationship
How long known?
Phone No.
Address
Email
example@example.com
Please Enter Home Phone
Please enter a valid phone number.
Should be Empty:

Adoptee

Release for Veterinary Reference

If you do not have a veterinarian reference, please provide two personal references in the spaces at the end of the form.

About You

Your Home

Pet Ownership History

Personal References