Sherry's CHS Dog Adoption Application

Today's Date*

MonthDayYearHourMinutesAM/PM Option

Pet's Name (if known)*

Litter Name (if known)*

Contact Information

Applicant Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Cell Number*

Is this number OK to text to? If no, we will send an email to the address provided below.*

YesNo

County*

How long at this address*

Place of employment*

Occupation*

How long?*

E-mail*

Check any and all that apply for applicant:

Under age 25Over age 65

Have you applied with Cherokee Humane Society before?*

Yes and I adopted!Yes but didn't adopt.No

Who and when did you adopt?

Dog's name & date adopted

When did you apply?

Date

Co-Applicant / Back-Up Caregiver (someone other than yourself, in the event you are not able to care for the dog) MUST BE AT LEAST 18 YEARS OLD.*

First NameLast Name

Relationship to Applicant:*

Phone/Cell Number*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long at this address?*

County*

Place of employment*

How long at this place of employment?*

Occupation*

E-mail*

Family & Housing

How many adults are in the household?*

What is their relationship to you?*

How many children in the household?*

What are the ages of the children?

What type of home do you live in?*

Name of Apartment Complex, Mobile Home Park or Sub Division.*

Please describe your household.*

How much do you think routine vet care costs yearly?*

What is your reason for adopting?*

Please explain your choice. (What type of emotional support, working dog or guard dog?)

Do you plan on registering the emotional support dog?

YesNo

What is your reason for adopting?*

Have you had Parvovirus at your home within the last 12 months?*

YesNo

If yes, please give date:

Your Current Pets

Do you have other pet(s) that you own and/or have living with you?*

YesNo

Pet #1 - (specify type, breed, sex, weight, temperament, name, age, indoor/outdoor or both)

Pet #2 - (specify type, breed, sex, weight, temperament, name, age, indoor/outdoor or both)

Pet #3 - (specify type, breed, sex, weight, temperament, name, age, indoor/outdoor or both)

Pet #4 - (specify type, breed, sex, weight, temperament, name, age, indoor/outdoor or both)

Are these pets up to date on vaccines?

YesNo

Are your dogs on heartworm preventive?

YesNoDon't have any dogs

Are your dogs on heartworm preventive?

YesNoDon't have any dogs

Are these pets spayed/neutered? If not, why.

Have you ever surrendered a pet or re-homed a pet? If so why & when.*

Have you ever had a pet euthanized? If so, why & when.*

Have you ever lost a pet to an accident? WHEN. If so, explain.*

How do you discipline your pets (or how will you discipline your new pet)?*

Veterinarian

Do you have a regular veterinarian?*

YesNo

Veterinarian's Name or Clinic Name*

First NameLast Name

Veterinarian's Phone Number*

Area CodePhone Number

Clinic Name & Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

About the Dog You Wish to Adopt

Desired Age:

Desired Age:*

Desired sex:*

Desired size, when full grown:*

Desired breed(s):*

Breed(s) you would not adopt:*

Average # of hours pet will spend alone daily*

Where will the dog spend the day? Be specific.*

Where will the dog spend the night? Be specific.*

Who will have primary responsibility for this pet's daily care?*

Who will have financial responsibility?*

Do you agree to provide regular health care by a Licensed Veterinarian?*

YesNo

Do you agree to keep the dog on monthly heartworm protection?*

YesNo

Do you agree to have the dog Micro Chipped?*

YesNo

Do you agree to a follow up phone call regarding the adoption/pet?*

YesNo

Do you agree to keep the dog as an indoor pet? If no, explain why not.*

How do you plan on supervising the pet while outside?*

Do you have a fence? If so, what type.*

DO YOU AGREE TO CONTACT CHS IF YOU CAN NO LONGER CARE FOR ITS HEALTH NEEDS? (CHS will help you, help your dog)*

YesNo

I UNDERSTAND THAT I MUST CONTACT SHERRY THOMAS AT (678) 480-0708 IF I CAN NO LONGER KEEP THIS PET I HAVE ADOPTED AND RETURN PET TO HER AT NO CHARGE WITH MEDICAL RECORDS.*

Type your initials here

DO YOU AGREE THAT THIS PET MAY ONLY BE RE-HOMED WITH FAMILY, A FRIEND, A NEIGHBOR, OR CO-WORKER, SOMEONE YOU TRUST ONLY? (CHS must be notified of this)

YesNo

I understand that I must return this pet to CHS if I intend to re-home the pet I adopt.*

Type your initials here

Are you willing to let a representative of CHS visit your home by appointment before and after adoption?*

YesNo

How much are you prepared to pay for emergency vet care?*

What energy/activity level of a dog would you like?*

How do you plan on exercising your new dog?*

Will you commit to a one on one in-home training class, if needed? Approximate cost is $90 to $120.*

YesNo

Are you prepared to care for this dog for up to 15 years?*

YesNo

I understand that I am adopting a rescue dog. CHS can only estimate the dog's age, breed, and adult weight.*

Type your initials here

Personal References

Please list someone who is familar with you, your home, and your pet(s) that does not live in your home and that is not a relative. Must be different than Back up Caregiver or Co-Applicant at beginning of application.

1. Reference Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Phone Number*

Area CodePhone Number

Relationship (neighbor):*

2. Reference Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Phone Number*

Area CodePhone Number

Relationship (friend or co-worker):*

Landlord/Property Manager

Do you own, rent or live with parents?*

OwnRentLive with Parents

If you live with parents, do your parents own or rent?

OwnRent

If you rent or live with parents, please give the property owner's name and number and the rules governing pets:

Landlord/Property Manager or Parents Name:

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Rules Governing Pets (specifically breed & weight restrictions):

Please Read the Following and Sign Below

Providing CHS with this information means you are allowing a CHS Representative to call your vet, property owner, and references during the application process. You agree that CHS may follow up with said contacts after adoption has taken place. You also agree that CHS may photograph or video you and your family for use in publication/media. Please understand our goal is to make sure these animals are placed in good homes. The responsibility of CHS is the best interest of the animals. CHS has the right to refuse an adoption for any reason. The application remains the property of CHS and there is a $10 application fee.

I certify that the above information in this application is true and accurate to the best of my knowledge. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Cherokee Humane Society reserves the right to annul the adoption and reclaim the animal.

It is understood that this adopted animal can be removed from my care at any time should I violate any of the following:

Allowing this animal to run loose - failure to provide current ID tags.
Failing to provide adequate food/water, shelter, companionship, and medical care.
Forcing the animal to live anywhere except inside the primary residence (example - garage), cats are strictly indoors.
Declawing, debarking, ear cropping or in any other way mutilating this animals for cosmetic or other purposes.
Tethering and/or chaining canines outside is strictly prohibited.
If you are no longer able to care for the adopted animal, you MUST contact Sherry Thomas at (678) 480-0708 to return the pet back to CHS with their medical records at no charge.

Once you submit your application, we should receive it within 24 hours. You will be notified that it has been received and has moved onto the review process.

Our application review process can take several days. The quicker you respond to any requests we may make for additional information, the quicker we can process your application.

If we are asking for additional information, it doesn't mean that you are the individual approved to adopt the dog, we are still reviewing your application. Please be aware that a single dog or puppy can receive multiple applications.

If we think your family would be a good fit for that dog/puppy, we will invite you to schedule a meet and greet appointment.

If the meet and greet goes well and the dog/puppy is a good fit for your family, you'll be able to leave with him that day.

Applicant Signature*

First NameLast Name

Date*

MonthDayYear

Applicant Signature*

Co-Applicant or Back-Up Caregiver Signature*

First NameLast Name

Date*

MonthDayYear

Co-Applicant Signature*

My Products

USDDescription

Credit Card

Cherokee Humane Society (CHS)

Dog Adoption Application Form

Contact Information

Family & Housing

Your Current Pets

Veterinarian

About the Dog You Wish to Adopt

Personal References

Landlord/Property Manager

Please Read the Following and Sign Below

Credit Card