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 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.
Alternative Phone Number
Date of Birth*

MonthDayYear
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?*

YesNo

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*
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?*

RentOwn
Name of Landlord/Company

First NameLast Name
Phone Number
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

Cancelof

Current Pets in the Home

Complete if you have any pets currently living in the home.

If you are going to list a vet, make sure you add the pets that attend that vet.

If you do not have current pets, you do not need to fill out either section.

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

Cancelof

Previous Pets in the Home

Complete if you have any past pets within 5 years.

If you are going to list a vet, make sure you add the pets that attend that vet.

If you do not have pets in the past 5 years, you do not need to fill out either section.

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

Complete if you have had any pets living in your home in the past 5 years and are no longer with you. (Passed away, rehomed, moved out, etc..)
Pets in the past 5 years
List the vet practices that you have used: (Ex. Chambersburg Animal Hospital, Tractor Supply, etc.)*

Primary Applicant