Adoption Application

Application for Adoption
About You:
Name of Primary Adopter: *
Name of Secondary Adopter:

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
Alt Phone Number

Area Code Phone Number
E-mail *
Age (s):
About Your Living Arrangements:
Type of Residence: *
If Other, please specify:
Do you: *
Please note that many rental contracts have breed restrictions associated with them therefore we have to verify this information before proceeding with the adoption process.
If RENT, please provide your landlord phone / email for verification if there are any breed restrictions.
How long at your current residence? *
Is there a fenced yard? *
Is there a busy street nearby? *
Preferences:
Name (if specific interest): *
Breed: *
Sex: *
Desired Age: *
What is the maximum age you would consider? *
Desired Color: *
Do you prefer: *
Do you have objections to a home visit by a rescue person? *
Is this pet for yourself or a gift? *
Are there children in the household? (List names, ages, genders): *
Do you currently own any other pets? *
If yes, please list name / breed / age / sex.
Have you ever surrendered an animal to a shelter? *
Is there any reason that would make you give up your pet? *
Please list dogs you have owned in past 10yrs.....list names and what happened to them: *
Do you have a dog crate? *
Where would this pet live? *
Have you ever obedience trained a dog? *
If Yes, what facility or facilities have you used? *
If desired breed is a chow chow, have you ever owned a chow before or familiar with the breed? *
If desired breed is a chow chow, how will you groom your chow chow and how often? *
NOTE: If desired breed is a chow chow, we prefer not to place 2 chows of the same sex in a home together. We will consider exceptions on a case by case basis.
References:
Veterinarian Name / Practice: *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
E-mail
Personal References (a person who has been in your home and preferably has seen how you cared for your past pets) – List name, phone and relationship:
Reference#1 *
Reference#2 *
List one person (name, phone, relationship) who would always be able to reach you, even if you moved. *
Is there anything else you would like us to know about your desire to own a rescue pet. *
How did you hear about us?
If Other, please explain:
By submitting this application, you give Houston Chow Chow Connection consent to contact the designated veterinary office for proof of medical records and / or treatment as well as contacting references.
***PLEASE NOTE: IF YOU DO NOT RECEIVE A CONFIRMATION MESSAGE WHEN YOU HIT THE "SUBMIT" BUTTON BELOW, PLEASE GO BACK AND MAKE SURE YOU HAVE FILLED OUT ALL OF THE MANDATORY FIELDS.***
Should be Empty:

About You:

About Your Living Arrangements:

Please note that many rental contracts have breed restrictions associated with them therefore we have to verify this information before proceeding with the adoption process.

Preferences:

References: