Adoption Application

Application for Adoption
About You
Name of Primary Adopter:*

First NameLast Name
Name of Secondary Adopter:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile/Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail*
Your Age(s) include secondary adopter, if applicable:*
Occupation
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 (enter N/A if you do not rent).*
If OWN a single-family home, condominium or town home in a community with any type of HOA, please provide the HOA name, phone and/or email (enter N/A if you do not own). *
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: 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 ages and 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 and how often?*
Veterinarian Reference

CURRENT
Veterinarian Name / Practice:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Veterinarian Reference

PAST
Veterinarian Name / Practice:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
example@example.com
Personal References

(a person who has been in your home and has seen how you cared for your past/current pets)
Reference#1*

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

Area CodePhone Number
Reference#2 (NOT A RELATIVE)*

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

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

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

Area CodePhone 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

Veterinarian Reference

Personal References