Adoption Application
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Emergency Contact
Phone number
Which Animal are you interested in?
Is this your first pet?
Do you have other pets in your home?
About my resident pets:
All are spayed or neutered
Up to date on their rabies vaccinations
Up to date on vaccinations other than rabies
Not spayed or neutered*
If not spayed or neutered, please explain:
Do you already have a veterinarian?
Yes
No
If yes, who?
Vet's phone number:
What do you plan to do with your pet?
Rows
Yes
No
Undecided
Companion
Outdoor activities such as jogging, hiking, etc
Hunting
Certification as a therapy dog
Guarding
Field work such as search & rescue
Are you currently a student?
Yes
No
If yes, your guardian's name and number:
Type of housing:
Single Family Home
Apartment/Multi-family/Condo
Townhome
Farm
Other
Do you:
Rent
Own
Landlord's name and number:
How long have you lived here?
How many adults are in your home?
Names of all of the adults:
How many minor children in your home?
How many children are under the age of two (2)?
Does anyone in the home have allergies to pets?
The pet will sleep and be kept here while you are away:
Outside in yard
Inside of home
Kennel
Tethered/exterior house
How many hours will the pet usually be left alone each day?
Less than 4
4 - 8 hours
8+ hours
Are you interested in fostering with C.C.A.R.?
Yes
No
Have you or anyone in the pet's future household ever been arrested, charged or convicted for animal cruelty or animal hoarding?
Yes
No
Do you agree to return the pet to C.C.A.R. should the adoption not work for any reason?
Yes
No
Do you acknowledge that all of the information you have given is true and complete? This animal will reside in your home as a pet. You will provide it with quality food, plenty of fresh water, indoor shelter, affection, annual physical examinations and vaccinations under the supervision of a licensed Veterinarian.
Yes
No
Your full name acknowledges the above statement to be true. You also understand that you will present a photo ID for verification purposes.
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: