Adoption Application

Application for Adoption
About You
Name of Primary Adopter: *

First Name Last Name
Name of Secondary Adopter: *

First Name Last Name
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 *
Your Age(s) include secondary adopter, if applicable:
About Your Living Arrangements

Please note that many rental contracts as well as homeowner associations for owned condominium or townhomes have breed and/or weight restrictions. Therefore we must verify current rules/regulations with them before proceeding with the application process.
Do you: *
Type of Residence: *
If Other, please specify:
If RENT, please provide your landlord name, phone and/or email for verification if there are any breed restrictions.
If OWN in either a condominium or town home, please provide your homeowner's association name, phone and/or 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 of dog (s) you are interested in, if applicable: *
Breed: *
Do you prefer: *
Sex (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): *
Desired Age: *
What is the maximum age you would consider? *
Desired Color: *
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? *
Veterinarian Reference
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)
Reference#1 *

First Name Last Name
Reference#1 Relationship *
Reference#1 Email *
example@example.com
Reference#1 Phone Number *

Area Code Phone Number
Reference#2 *

First Name Last Name
Reference#2 Relationship *
Reference#2 Email *
example@example.com
Reference#2 Phone Number *

Area Code Phone Number
List one person who would always be able to reach you, even if you moved. *

First Name Last Name
Relationship *
Email *
example@example.com
Phone Number *

Area Code Phone Number
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:

Application for Adoption

About You

About Your Living Arrangements

Preferences

Veterinarian Reference

Personal References