Animal Shelter Adoption Application Form

Chester Veterinary Clinic 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:*
How do you prefer to be contacted?*

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:*
Are you considering adopting more pets in the future?*

YesNo
Choose which best describes your level of dog owning experience:*

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?*
Are you concerned with any of the following behaviors?*

JumpingBarkingPulling on leashRefusal to be handledMouthingFear/AnxietyI am not concerned with any of these behaviorsOther
Which of these behaviors are you willing to work through?*
What activities would you like to do with your new pet?*
Briefly describe your average day:*
Are there any specific preferences or personality traits you are looking for?*
What kind of food do you plan on feeding your new pet?*
Would you consider adopting a pet with existing medical needs, that are currently being treated?*

YesNoMaybe
If Chester Veterinary Clinic is unable to board your animal, who will care for the animal during the times you are away?*
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? (Please list two references with phone numbers)*
Household Information:
Do you consent to a brief home visit, prior to finalizing the adoption of your new pet?*

YesNo
Are all members of your household in agreement with this adoption?*

YesNoI Don't Know
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoOther
Do you own or rent?*

OwnRent
If renting, please provide name and contact number for landlord/property management:*
Does your landlord/property management/HOA allow dogs at your residence?*

YesNo
Are there any restrictions from your landlord/property management/HOA?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Size of your backyard:*

SmallAverageLargeExtra Large (Corner lot)Patio (No Yard)
Do you have a fully fenced yard?*

YesNo
Height & type of fence: (N/A if not applicable or no fence)*
Where will the pet be kept when you are not home?*
Does your yard include a pool?*

YesNo
How many adults are in your household?*
How many children are in your household?*
Please list children's ages:(N/A if no children)*
Have children in the home been around animals, before?*

YesNo
Does anyone in your home have asthma or pet related allergies?*

YesNo
Household Activity Level:

QuietActiveVery ActiveJust MeOther
Please list 2 personal references with phone numbers: *
Current/Previous Pet Information:
Do you currently have pets?*

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?*
Have you adopted from a rescue group or shelter, previously?*

YesNo
If yes, which rescue/shelter?*
Have you ever had to surrender an animal?*

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):*
Which of the following would you like more information on?*

VaccinesParasitesHeartworm/PreventionFlea/TickSpay/NeuterSocializationTrainingNone
Do you have a vet you use, currently?*

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)*
Preferred activity level:*

High Energy/Jogging buddyModerate ActivityLow ActivityCouch Potato
Do you plan on crate training your new pet?*

YesNo
Have you ever potty-trained an animal before?*

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?*
How hear about CVC?*

GooglePetfinder.comFacebookPetharbor.comInstagramFriend/FamilyOther
Please allow The ARRC team 2-3 business days to process your application. You will be contacted by phone or email, provided.

Thank You for considering an ARRC pup!
- 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 pet does not guarantee adoption
- I understand that Chester Veterinary Clinic spends a minimum of $500 in vetting costs per intake, & adoption fees are donations towards care & medical needs to continue to help each rescue animal who takes the place of an adopted one.
Should be Empty:

Chester Veterinary Clinic Adoption Application

Applicant Information:

About Applicant:

Household Information:

Current/Previous Pet Information:

Adoption Information: