Central Pennsylvania Humane Society Dog Adoption Application

Adoption Pricing

Dog Under a year - $400

Dog 1-5 years - $300

Dog 6-8 years - $150

Dog 9+ years - $80

Senior to Senior Program - $30

** When adopting a dog under a year of age, we require HALF (50%) of the adoption fee when you take home the dog. This is to ensure the adopter is serious about committing to a puppy! **

The above adoption fee includes: Spay/Neuter Surgery, Vaccinations (Distemper, Bordetella, and Rabies Vaccine), Flea/Tick Treatment, Dewormer, Microchip, 4DX test for dogs over the age of 6 months, and general care while being with CPHS.

We do offer a 20% discount for veterans and first responders.

Please visit our Facebook Page - Adoptable Dog Album to view all our available dogs. If a dog is no longer available, we will update his/her post stating "No Longer Available."

We do require a $5.00 application fee. Your application will stay on file for six months. You will be prompted to pay the adoption fee at the end of the application.

Our full adoption process and criteria is at the end of the application.

Please initial that you have read and understand the adoption pricing:

First choice of dog (Name) - Please note #1333 is our kennel license not an animal!

Second choice of dog:

Third choice of dog:

Primary Applicant:

First NameLast Name

Secondary Applicant:

First NameLast Name

Email Address:

example@example.com

Phone Number:

Format: (000) 000-0000.

Drivers License Number:

Date of Birth:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

What county are you located in?

Are you 65 or older?

Are you a first responder or veteran?

Do you own any pets?

Are all your pets currently spayed or neutered?

Please list all of your current pets by species, name, sex, age, and where the animal is currently at now. If the animal is NOT spayed/or neutered, please include that information.

Name of pet not spayed or neutered:

Veterinarian Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Veterinarian Name:

First NameLast Name

Do you own or rent your home?

Please provide your landlord's name and phone number here **Please note we must have this information to consider your application! ** :

Do you have a fenced in yard?

If you do not have a fenced in yard, how do you plan to take your new dog outside? Example: Tie Out, Walk on Leash, etc. If you do have a fenced in yard, please put N/A.

Are there any breed or size restrictions for where you live?

Have you ever surrendered a pet you owned to any animal shelter or rescue including a "low" or "no kill" shelter?

If you answered yes above, please list the reason why.

If your adopted pet starts showing signs of aggression toward the other animals in the home, how will you handle the situation?

Dogs will require training to help make them better members of the family and well-behaved companions. Are you willing to take on the added expense, time and commitment to help a dog become a compatible family member?

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?

Are there children in the home? (If yes, please list ages)

How many adults are currently living in the home?

Will you crate your pet?

How many hours per day would the pet be alone?

If you have to leave town, emergently or planned, where would your pet stay?

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?

In case of an unforeseen circumstance, please list the name of an individual and phone number of who would be responsible for caring for your new adopted pet.

By clicking the submit button, I agree to the CPHS adoption process.
By clicking the submit button, I understand that all people living in the home must meet the dog, all dogs in the home must come in to meet the dog I am interested in, current rabies vaccines for cats and dogs in the home must be submitted to CPHS, and if renting where I reside, landlord contact must be made by CPHS prior to sending an animal home.
By clicking the submit button, I understand that prior to the animal being fully adopted, that the animal must be spayed or neutered on the schedule of CPHS.
By clicking the submit button, I understand if a personal, financial, health or some other situation arises and I cannot keep my pet, that I am responsible for my pet. CPHS has a high volume of animals that come into our facility. We may not be able to accommodate or bring the dog back into our facility if they are fully adopted (space permitting). You can contact our facility to be placed on our Owner Surrender list. You may also contact other facilities to see if they are able to accept the animal or be placed on their waitlist. If the animal develops behavior or aggression issues, we recommend contacting a Dog Trainer, Animal Behaviorist, or Veterinarian to help solve these issues.
By clicking the submit button, I agree to indemnify and hold harmless CPHS against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that CPHS will disclose any of the pet's health, behavior issues or bite history known by the above named rescue group before adoption is completed.
By clicking the submit button, I understand Pennsylvania State Law requires that all puppies/dogs that are three (3) to four (4) months of age or older shall receive regular vaccinations against rabies. We also urge the following precautions: The pet should receive annual vaccines as recommended by your veterinarian. The pet should always wear a safety collar with curent identification information and rabies tag.
By clicking the submit button, I verify all of the above information is true and accurate.

** Please Note: We CANNOT HOLD ANIMALS! Please keep in mind that there is no such thing as a "Perfect Pet." Any adopted animal will require training, patience, and ample time to adjust to its new home. While we carefully monitor animals surrendered to CPHS, we have limited knowledge of their background. Therefore, we cannot guarantee the health, behavior, age, gender, breed, or any other information of any animal adopted from the shelter. **

Please sign below that you have read the above.

Signature

Once you submit an application, you are required to:

- Visit the animal you are applying for. We are unable to call every applicant to schedule a visit. We ask that you visit the adoptable dog as soon as possible. Some breeds are extremely popular. We ask that you call prior to traveling to the shelter to ensure the dog you are interested in is still available. Our phone number is: 814-942-5402.

- Everyone in the home must visit. We do this to make sure everyone is on board with getting a new dog due to the committment it takes when bringing home a new family member.

- Please remember we do require ALL dogs in the home to visit with the dog you are looking to adopt. We always ask that you prepare for this and bring your dog(s) with you when you come to visit. We want to ensure that our dog and your dog(s) are comfortable with each other!

- We do NOT preapprove applications. We require the application to visit with the dog you are applying for in our visitation rooms. We base our approval off of the interactions we see between the adopters, their dog(s) if applicable, and our adopted pet.

- Our application is NOT first come first serve.

- If you need a visitation time outside our normal operating hours, please call us at 814-942-5402 to schedule a visit.

- We are unable to call every applicant when the dog is no longer available. If you applied for a dog, please call us at 814-942-5402 to see if the dog is still available or keep an eye on our Facebook page, as we will update the adoptable dog album first. If approved for the dog, you will receive a call from us. Please be prepared to welcome your new dog into your home as soon as possible, as we can't hold dogs.

Our hours:

Monday: Closed

Tuesday-Thursday: 12:30pm - 4:30pm

Friday: 12:30pm - 7:00pm

Saturday/Sunday: 12:30pm-4:30pm

Please initial that you have read and understand our application and visitation process:

*** Once you submit an application, you are required to: visit the animal you are applying for. We do not preapprove applications. We approve applications based on the interactions during the meet and greet.** We do require everyone in the home visit, as well as dogs. This is to help ensure everyone is on board with bringing a new dog home and that our adoptable dog is also comfortable! We receive a large volume of applications on a daily basis and are unable to reply to every submitted application. If you submit an application and are traveling to us, please call us prior to leaving to ensure the pet you would like to meet is still available. 814-942-5402. We do not always have the ability to call every applicant that has not fully completed the visiting requirements after submitting the application, therefore, only those who are approved for the dog will be contacted. We do not operate on a first come, first serve basis. If you need a visiting time outside of our normal operating hours, please call us to arrange this with our staff members. Please initial in the below box that you have read the above and understand after hitting submit, you are required to visit. ***

Date

Signature of Primary Applicant:

Signature of Co-Applicant:

My Products

CPHS Adoption Application

$5.00 Quantity

Total

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