Adoption Application

Adoption Application

Thank you for choosing the Cumberland Valley Animal Shelter to help you find your new best friend! Please fill out the form below fully and clearly.
Email
What is the name of the animal you are interested in? If there is no one specific, or if you are looking for a particular animal, please either list "Open (Dog, Cat, Other)", or list the type of animal you are looking to adopt (ex. small dog, long hair cat, etc.)

Primary Applicant

Below, please fill out all of your information
Name

First NameLast Name
List any other name(s) you have gone by (ex. maiden name, nicknames)
Phone Number
Enter a valid phone number.Format: (000) 000-0000.
Alternative Phone Number
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you have not lived in your current home for 5 years, please list the previous address(s)
Are you planning to move in the next 6 months?

Other Adults in the Home

Below, complete if there are other adults 18 years and older living in the home (partner(s), parents, children, siblings, roommates, etc...)
Other Adults in Home

Microchip

All animals available for adoption are microchipped before going to their fur-ever home; list someone who does not live in the home as an emergency contact.
First & Last Name of Microchip

First NameLast Name
Phone Number
Format: (000) 000-0000.
Relationship to Primary Applicant

Rent or Own

Fill out below if you rent or own your home. If you have lot rent, please provide who you pay lot rent to. If you own, please put "N/A" in box
Do you rent or own your home?
If your living situation is not reflected as plainly as in the options provided (rent/own) please explain below:
Example: My parents own the home but I live there without them, I'm doing rent-to-own, I own my home but pay lot rent, etc.
Name of Landlord/Company

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
To expedite your application, feel free to attach a copy of your lease proving you can have pets in the home/stating any pet policies

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Current Pets in the Home

Please complete if you have any pets currently living in the home.

If you do not have current pets, you do not need to fill out either section (you may put N/A for veterinary practice used).

If you are confused at all for this section, please reach out to us before submitting.
Current pets in Household
List the vet practices that you have used: (Ex. Chambersburg Animal Hospital, Tractor Supply, etc.)
To expedite your application, attach vet records confirming vaccines for your pets in the home currently/were in the home in the past 5 years

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Previous Pets in the Home

Complete if you have any past pets within 5 years.

If you do not have pets in the past 5 years, you do not need to fill out either section (please write N/A for veterinary practice used if you have not had pets within the past five years)

Past pets include: deceased, rehomed, moved out, etc.

If you are confused at all for this section, please reach out to us before submitting.
Pets - Past 5 Years

Please complete this section if you have had any pets living in your home within the past 5 years who are no longer with you. For each pet, include the reason they are no longer in the home (e.g., passed away, rehomed, moved out, etc.) and the year this occurred.
Pets in the past 5 years
List the vet practices that you have used: (Ex. Chambersburg Animal Hospital, Tractor Supply, etc.)

Primary Applicant