Chesterfield Shelter Adoption Application

Chesterfield County Animal Shelter Adoption Application
Applicant Information:
Your Name (First & Last):*
Street Address:*
City, State, Zip*
Phone Number:*

Area CodePhone Number
Alternate Phone:

Area CodePhone Number
E-mail:
Employer:*
PhoneTextEmail
About Applicant:
Please provide the name of the pet you are interested in, or "No Preference"*
Please list all current pets in the household: (Breed, age, spayed/neutered)*
Please list previous pets from the last 5 years & where they are now:*
YesNo
Advanced (Dog behavior & training background)Intermediate (Always owned dogs)First Time (Never had a dog)Not applying for a dog
What qualities are you looking for in a companion?*
JumpingBarkingPulling on leashRefusal to be handledMouthingFear/AnxietyI am not concerned with any of these behaviorsOther
What activities would you like to do with your new pet?*
Are there any specific preferences or personality traits you are looking for?*
What do you plan to do with the animal if you move? What if there are restrictions pertaining to your pet?*
Who will inherit the animal in the event of a death? *
Household Information:
YesNoI Don't Know
Who will be the pet's primary caregiver?*
HouseApartmentCondoOther
OwnRent
If renting, please provide name and contact number for landlord/property management:*
YesNo
Number of petsSize or weight restrictionsBreed restrictionsNone
SmallAverageLargeExtra Large (Corner lot)Patio (No Yard)
YesNo
Where will the pet be kept when you are not home?*
How many adults are in your household?*
How many children are in your household?*
Please list children's ages:(N/A if no children)*
YesNo
YesNo
QuietActiveVery ActiveJust MeOther
Please list a personal reference with phone number: *
Current/Previous Pet Information:
YesNo
Please list all current pets: (Breed & Age included) (N/A if no pets)*
Are your pets up to date on vaccines & preventatives? If not, briefly explain why:*
How many of these pets are spayed/neutered?*
YesNo
If yes, which rescue/shelter?*
YesNo
If yes, please briefly explain the circumstances?
Please list any pets you have owned in the last five years & where they are now: (N/A if not applicable):*
VaccinesParasitesHeartworm/PreventionFlea/TickSpay/NeuterSocializationTrainingNone
YesNoI would like help finding one
If so, please provide the name, address, & phone number of your vet:
Adoption Information:
Briefly explain why you are interested in adopting? (N/A for Fosters)*
High Energy/Jogging buddyModerate ActivityLow ActivityCouch Potato
YesNo
YesNo
How do you plan on exercising your new pet & how many days per week?*
How many hours each day will your new pet be home alone?*
Where will your pet stay when your are not home?*
Where will your new pet sleep at night?*
How do you plan on helping your new pet best adjust to their new home?*
What will you do if bad habits form?*
Under what circumstances would you have to give up your pet?*
GooglePetfinder.comFacebookInstagramFriend/FamilyOther
- I agree that the information I have provided is true
- I understand that applying does not guaruntee adoption
- I understand that a meet & greet with a dog does not guaruntee adoption
- I give premission to check my references and information listed as true.
Name

First NameLast Name
Please allow our team 1-2 business days to process your application. You will be contacted by phone or email you provided.

Thank You for considering adopting from The Chesterfield County Animal Shelter!
Should be Empty:

Chesterfield County Animal Shelter Adoption Application

Applicant Information:

About Applicant:

Household Information:

Current/Previous Pet Information:

Adoption Information: